DELAFIVLD 


An  Inaugural.  Dissertation 
pulmonary  Consumption 


flf-KC?// 


^i2 


Columbia  (Hntoetsitp 

College  of  iPjjpgtctans  anb  Hmrgeons 
Hi&rarp 


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AN 


91  naugural  ^iggettatian 


ON 


PULMONARY  CONSUMPTION 


BY  EDWARD  DELAFIELD,  A.  B. 


■For  want  of  timely  care, 


Millions  have  died  of  medicable  wounds.     Armstrong. 


NEW- YORK: 

PBINTED    BY    JOHN    FORBES    &    CO. 
78    WALL-STREET. 

1816. 


7)3?-, 


> ■■/.  y 


TO 

SAMUEL  BORROWE,  M.  D. 

ONE    OF    THE    SURGEONS  OF   THE  NEW-YORK  HOSPITAL., 

'       THIS  DISSERTATION 

IS  DEDICATED, 
AS  A  TESTIMONY  OF  GRATITUDE 
FOR  THE  MANY  VALUABLE  PRACTICAL  LESSONS 

RECEIVED  FROM  HIM 

BY  HIS  FRIEND  AND  PUPIL, 

EDWARD  DELAFIELD. 


INTRODUCTION, 


THE  attention  of  Physicians  has  for  several  years  past 
been  excited  to  the  consideration  of  that  inveterate  enemy 
of  the  human  race,  the  Consumption.  Several  works 
have  been  published,  new  remedies  proposed,  and  the 
practice  of  former  physicians  revived  with  modifications 
and  amendments,  in  the  treatment  of  this  disease.  At  one 
period,  Consumption  had  been  so  long  considered  with- 
out the  reach  of  remedies,  that  it  had  almost  ceased  to 
excite  the  enquiries  of  the  learned  in  medicine.  Fortu- 
nately, however,  the  spirit  of  enquiry  has  revived  ;  and  it 
is  believed  that  the  treatment  of  this  dreadful  malady  has 
been  so  far  improved,  that  many  are  rescued  from  its 
grasp,  and  the  sufferings  of  those  who  are  still  its  victims, 
are  materially  mitigated.  Notwithstanding,  it  appears 
that  in  this  city  the  mortality  from  Consumption  has 
increased  rapidly  of  late  years.  Formerly,  its  climate 
was  considered  remarkably  salubrious,  and  diseases  of  the 
lungs  were  rare.  Lieutenant  Governor  Colden,  in  a  series 
of  remarks  on  the  climate  and  diseases  of  New- York, 
made  seventy  years  ago,  has  the  following  observations : 
"  The  air  of  the  country  being  almost  always  clear,  and 
its  spring  strong,  we  have  few  consumptions  or  diseases  of 
the  lungs.  People  inclined  to  be  consumptive  in  England, 
are  often  perfectly  cured  by  our  fine  air  ;  but  if  there  be 
ulcers  formed,  they  die.     The  climate  grows  every  day 


VI 

better,  as  the  country  is  cleared  of  the  woods ;  and  more 
healthy,  as  all  the  people  that  have  lived  long  here  testi- 
fy. This  has  even  been  sensible  to  me,  though  I  have 
lived  but  about  twelve  years  in  this  country ;  I  therefore 
doubt  not  but  it  will  in  time,  become  one  of  the  most 
agreeable  and  healthy  climates  on  the  face  of  the  earth."a 
These  anticipations  have  not  been  realized  ;  but,  on  the 
contrary,  Consumption  has  become  the  prevailing  disease 
of  our  city.  The  causes  of  this  increase  of  the  disease  are 
numerous.  We  are  told  by  Dr.  Rush,  that  it  is  unknown 
among  the  Indians  of  North  iVmerica;  that  it  is  scarcely 
known  by  those  citizens  of  the  United  States  who  live  in 
the  first  stage  of  civilized  life,  and  are  generally  called  the 
first  settlers ;  that  it  is  less  common  in  country  places  than 
in  cities,  and  increases  in  both,  with  intemperance  and  se- 
dentary modes  of  life ;  that  ship  and  house-carpenters, 
smiths,  and  all  those  artificers,  whose  business  requires 
great  exertion  of  strength  in  the  open  air,  in  all  seasons 
of  the  year,  are  less  subject  to  this  disease  than  men  who 
work  under  cover,  and  at  occupations  which  do  not  re- 
quire the  constant  action  of  their  lungs.  By  applying 
these  facts  to  the  situation  of  this  city,  the  causes  which 
have  produced  the  increased  mortality  from  consumption, 
become  evident. 

1.  The  growth  of  the  city,  and  consequent  state  of  the 
atmosphere,  most  distant  from  that  of  the  pure  air  of  the 
country. 

2.  The  increase  of  all  those  causes  which  have  ener- 
vated the  bodies  of  men,  and  rendered  them  more  suscep- 
tible to  the  influence  of  a  variable  climate.  Among  these 
are,  augmentation  of  wealth,  and  consequently,  luxury ; 
increased  dissipation,  with  its   accompaniment,  impru- 

*  Araer.  Med.  and  Phil.  Reg.  Vol.  I. 


Til 


deuce  in  dress ;  and  extension  of  manufactures,  affording 
greater  opportunity  for  sedentary  employments,  and  expo- 
sure to  an  insalubrious  atmosphere.  In  general,  the 
causes  are,  all  those  circumstances  which  tend  to  remove 
man  farthest  from  that  situation,  in  which  the  body  is 
possessed  of  the  greatest  vigour,  and  of  course,  least  sub- 
ject to  disease,  that  of  the  savage.  In  proportion  as  the 
city  has  enlarged,  these  causes  have  continued  to  increase, 
and  probably  still  will  do  so.  But  in  Great  Britain,  they 
appear  already  to  have  attained  their  acme,  and  as  a  con- 
sequence of  the  improvements  in  medicine,  the  causes  not. 
increasing,  the  disease  is  on  the  decline.b 

The  following  statement  will  show  the  proportion,, 
which  the  number  of  those  who  die  from  consumption, 
bears  to  the  whole  number  of  deaths,  in  this  city,  during 
the  last  twelve  years. 

In  1804,  499  persons  died  from  Consumption,  and  were 
to  the  whole  number  of  deaths,  2125  as  1  to  4.25. 


In  1805. 

...462. 

. ..2352 

1806. 

...354. 

...2225 

1807. 

...464. 

...2312 

1808. 

...429. 

...2014 

1809. 

...413. 

...2108 

1810. 

...569. 

...2158 

1811. 

...595. 

...2524 

1812. 

...669. 

...2553 

1813. 

...562. 

...2229 

1814. 

...618. 

...2507 

1815. 

...572. 

...1974 

,5.09 

,6.28 

,4.94 

.4.69 

.5.1 

.3.79 

.4.24 

,3.81 

.3.96 

.4.04 

,3.8 


Dr.  Lettsom  observes,  that  Consumption  is  decreasing  in  Great  Britain. 

Med.  and  Phil.  Reg, 


Vlll 

From  this  statement   it  appears,  that  the  number  of 
deaths  from  Consumption  has  gradually  increased.     The 
average  proportion  during  the  period  mentioned,  is  as  1 
to  4.36.     Nearly  one  fourth  of  all  those  who  die  in  this 
city  are  destroyed  by  this  fatal  disease. 

These  facts  prove  indeed  that  the  power  of  medicine 
has  little  control  over  so  destructive  a  malady.  But  it 
should  not  therefore  paralyse  our  exertions.  From  what 
has  been  done  already,  in  improving  our  knowledge  of  its 
nature  and.  treatment,  a  hope  may  be  indulged  that  con- 
sumption may  one  day,  like  many  other  maladies  formerly 
deemed  incurable,  be  placed  no  longer  among  that  num- 
ber. 


INAUGURAL  DISSERTATION 


ON 


PULMONARY  CONSUMPTION. 


THE  term  Phthisis,  or  Consumption,  in  its  broadest 
sense,  is  applied  to  all  those  diseases,  in  which  the,  system 
sinks  under  a  gradual  waste  of  the  powers  of  life.  These 
diseases  may  be  divided  into  two  great  classes — 1.  That 
form  of  Consumption  in  which  the  lungs  are~unafFected. 
— 2.  Phthisis  Pulmonalis,  properly  so  called,  where  the 
lungs  are  the  seat  of  the  disease. 

Under  the  first  class  are  included, 

1.  Atrophia,  or  Consumption  from  want  of  nourishment, 
or  excessive  evacuations,  but  without  hectic  fever;  ex- 
cluding all  those  forms  of  disease  produced  by  immode^ 
rate  evacuations,  in  which  the  lungs  become  affected. 

2.  Tabes,  accompanied  with  hectic  fever,  frequently  at- 
tended with  disease  of  the  mesenteric  glands,  and  produ~ 
ced  most  commonly  by  scrophula. 

The  second  class,  Phthisis  Pulmonalis,  to  the  consider- 

B 


10 

ation  of  which  this  essay  will  be  more  immediately  con- 
fined, may  be  also  subdivided  into, 

1.  Primary,  where  the  lungs  are  the  original  seat  of  the 
disease,  and  as  a  consequence,  the  general  system  becomes 
affected. 

2.  Secondary,  where  the  system  being  first  reduced  by 
any  debilitating  cause,  the  lungs  become  secondarily 
affected,  as  a  symptom  of  the  general  disease. 

These  two  forms  of  Consumption,  although  somewhat 
similar  in  their  symptoms,  yet  proceed  from  opposite 
causes,  and  require  opposite  treatment.  The  one  is  a  dis- 
ease of  pure  inflammation ;  the  other  of  unmixed  debility. 
In  the  one,  an  active  antiphlogistic  treatment  is  necessary ; 
in  the  other,  the  system  requires  all  the  support,  which 
tonics  and  good  nourishment  can  afford. 

Phthisis  Pulmonalis  is  thus  defined  by  Dr.  Cullen, 
u  Corporis  emaciatio  et  debilitas,  cum  tussi,  febre  hectica,  et 
expectoratione purulenta"  This  definition  is  peculiary  in- 
correct, because  it  leads  us  to  neglect,  the  first  stage  of 
the  disease ;  if  the  symptoms  of  an  Incipient  Phthisis 
were  stated  to  us,  and  we  were  asked,  what  was  the  dis- 
ease, from  this  definition  we  would  be  perfectly  at  a  loss 
for  an  answer.  Except  the  cough,  none  of  the  symptoms 
there  stated  are  to  be  found  in  the  first  stage  of  Consump- 
tion. And  yet  that  is  as  truly  a  part  of  it,  and  of  as  much 
importance  to  the  practitioner,  as  the  last  stage,  which 
alone  is  included  inCullen's  definition.6 

c  The  following-  judicious  remarks  on  this  subject  are  made  by  Bayle,  in  his 
"  Recherches  sur  la  Phlhisie  Pulmonaire,  d'apres  la  notion  que  j'ai  donnee  de  la- 


II 

Agreeably  to  this  definition,  in  his  view  of  Phthisis  Pul- 
monalis,  Dr.  Cullen  makes  ulceration  of  the  lungs  and 
hectic  fever  essential  to  its  existence,  and  seems  rather  to 
consider  the  preceding  symptoms  a  cause  of  this  ulcera- 
tion and  fever,  than  as  constituting  an  integrant  part  of 
the  disease. 

Nor  is  the  place  assigned  by  him  to  Phthisis  Pulmon- 
ulis,  in  his  Nosological  Arrangement,  more  correct  than 
his  definition  of  it  He  places  it  in  the  order  Haemorr- 
hagiae,  and  considers  it  merely  as  a  consequence  of  Haemop- 
tysis. Even  if  it  were  always  excited  by  haemorrhage 
from  the  lungs,  it  would  be  improperly  thus  placed;  but 
as  that,  even  by  Dr.  Cullen,  is  considered  merely  as  one 
among  many  exciting  causes,  the  arrangement  is  altogether 
inadmissible.  But  if  it  be  admitted,  according  to  the 
view  which  will  be  hereafter  taken  of  Haemoptysis  in  this 
treatise,  that  it  is  rather  a  symptom  than  a  cause  of  Con- 
sumption, the  propriety  of  another  arrangement  will  be 
evident.  Accordingly  Phthisis  Pulmonalis  is  placed  by 
Dr.  Hosack,  as  one  of  the  Phlegmasia^.  This  disposition 
appears  to  be  the  most  proper  that  has  hitherto  been 
suggested,  and  as  such  I  shall  adopt  it.     But  before  we 

Phthisie  Pulmonale,  on  voit  que  je  dois  regarder  eomme  Phthisiques  des 
individus  qui  n'ont  ni  fievre,  ni  maigreur,  ni  expectoration  purnlente :  il 
suffit  que  les  poumons  soient  aff'ectes  d'ime  lesion  qui  tend  a  les  desor- 
ganiser  et  a  les  ulcerer.  On  ne  doit  pas  reg-arder  cette  lesion  uae  simple  cause 
de  la  Phthisic,  mais  comme  le  premier  temps  de  cette  maladie,  puisqne  la  Phthisie 
est  cette  lesion  meme  dont  la  continuation  et  le  developement  successif  amenent 
la  raort.  II  seroit  done  bien  peu  raisonnable  de  vonloir  attendre,  pour  reconnoitre 
la  Phthisie  Pulmonaire,  quelle  fut  constamment  parvenue  a  son  dernier  degre, 
qui  est  le  moment  ou  ses  symptomes  pathognomouiques  sont  bien  marques." 


12 

can  ascertain  the  character  and  treatment  of  any  diseases, 
it  is  necessary  minutely  to  examine  their  causes  and  symp- 
toms. 

Primary  Phthisis  Pulmonale  first  claims  our  attention. 
Its  predisposing  causes  may  be  mostly  arranged  into  five 
classes,  as  they  depend  on  organization,  age,  sex,  occupa- 
tion and  climate. 

Organization  predisposes  to  Consumption,  by  mal-con- 
formation  of  the  chest,  which  may  be  either  natural  or 
accidental ;  and  an  hereditary  internal  structure  not  de- 
pending on  the  external  form  of  the  thorax.  For  it  is 
observed,  that  in  some  instances,  those  who  have  every 
part  of  the  external  configuration,  such  as  is  generally  at- 
tributed to  persons  predisposed  to  Consumption,  yet  shall 
be  free  from  this  disease ;  while  on  the  other  hand,  some 
whose  chests  are  externally  perfectly  well  formed,  have 
been  subject  to  catarrhal  and  inflammatory  complaints  of 
the  lungs,  terminating  in  Phthisis.  The  form  of  chest  pe- 
culiar to  many  Phthisical  patients,  "  is  occasioned  by  the 
sternal  or  breast-bone  being  pressed  too  much  in  upon  the 
substance  of  the  lungs:  thus  the  clavicles  and  shoulder* 
blades  are  thrust  out  of  their  proper  position,  and  made 
to  assume,  in  some  measure,  the  form  of  wings,  to  which 
indeed  they  have  been  with  propriety  compared,  just 
raised  from  the  body  and  about  to  expand  for  flight.  By 
this  internal  direction  of  the  sternum,  the  full  expansion 
and  proper  sweep  of  the  ribs  is  likewise  prevented,  and 
an  unnatural  curvature  or  prominence  is  occasioned  on 
either  side  of  the  breast,  with  a  corresponding  central  de~ 


13 

pression."d  This  is  the  peculiar  form  to  which  the  term 
narrow  chest  is  generally  applied.  A  flattened  or  any 
other  unnatural  figure  of  the  chest  may  produce  the  same 
injury. 

The  thorax  may  become  accidentally  malformed  from 
any  violence  done  to  it,  particularly  during  infancy.  A 
frequent  source  of  it  is  the  mode  of  fashionable  dress 
adopted  by  females.  The  corset,  to  which  I  allude,  when 
worn  only  with  moderate  firmness,  and  by  those  not 
otherwise  predisposed  to  Phthisis,  serves  but  to  add 
elegance  and  beauty  to  the  female  figure ;  but  when  ap- 
plied with  the  object  of  converting  into  a  delicate  and 
slender  waist,  one  naturally  otherwise,  it  cannot  but  do 
injury.  By  immoderate  pressure,  it  converts  a  well 
formed  chest  into  the  deformed  and  narrow  one,  or  at 
least  an  approximation  to  it,  which  has  just  been  de- 
scribed. In  our  own  city  and  time,  too  many  fatal  ex- 
amples of  the  deleterious  effects  of  this  fashion  have 
occurred,  to  permit  us  to  retain  any- doubts  on  the 
subject. 

The  internal  constitution  of  the  body  predisposing  to 
Phthisis,  independent  of  external  form,  has  been  generally 
attributed  to  scrophula.  English  authors  are  particularly 
fond  of  making  Consumption  another  form  of  that  Protaean 
disease.  We  are  much  disinclined  to  concur  in  this 
opinion  from  the  fact,  that  the  mass  of  those  who  labour 
under  the  disease  in  question,  and  cases  too,  which,  after 

a  Dr.  Reid. 


14 

death  show  that  tuberculated  state  of  the  lungs,  generally 
ascribed  to  scrophula,  evince  no  other  of  the  numerous 
symptoms  of  that  disorder.  The  supposition  that  tuber- 
cles were  scrophulous,  probably  originated  from  the 
opinion  that  they  are  diseased  glands  ;  an  idea  now  suffi- 
ciently exploded.  This  hereditary  predisposition  we 
know  to  exist,  but  of  its  mode  of  action  we  are  totally 
ignorant.  In  this  city  there  are  many  melancholy  exam- 
ples of  whole  families  successively  falling  victims  to  Con- 
sumption, and  sufficiently  proving  its  hereditary  nature. 
But  an  hereditary  predisposition  does  not  necessarily  pro- 
duce Consumption.  It  is  not  uncommon  for  parents  who 
inherit  this  taint,  to  remain  free  from  disease  of  the  lungs, 
by  the  pursuit  of  laborious  occupations.  Nor  is  it  more 
uncommon  that  the  children  of  these  very  parents,  whose 
active  industry  had  preserved  their  lives,  and  amassed 
them  wealth,  should  by  being  enabled  to  indulge  in  ease 
and  luxury,  fall  victims  to  an  inherited  Consumption. 

So  the  females  of  a  family  are  sometimes  all  consump- 
tive, while  the  males  are  free  from  pulmonary  disease,  in 
consequence  of  the  more  sedentary  mode  of  life  of  the 
former. 

Although  no  period  of  life,  from  infancy  to  old  age,  is 
exempt  from  Consumption,  but  all  are  liable  to  its  attack, 
yet  at  a  particular  age,  it  is  observed  to  appear  more  fre- 
quently than  at  any  other.  This  period  commences 
about,  or  soon  after  the  age  of  puberty,  and  terminates  at 
thirty-six;  the  period  at  which  inflammatory  diseases 
most  generally  occur. 


15 

Sex  also  gives  a  predisposition  to  Consumption.     Fe- 
males are  more  frequently  affected  by  it  than  males.    This 
may  be  attributed  to  their  greater  delicacy  of  constitution, 
and  nervous  temperament.     Their  comparatively  sedenta- 
ry habits  of  life  add  to  this  peculiar  constitution.     But 
improper  compliance  with  the  requisitions  of  fashion  and 
taste  constitutes  not  a  small  part  of  the  greater  susceptibi- 
lity of  females  to  Phthisis.     Independent  of  the  use  of 
corsets,   the  small  quantity  of  clothing  frequently  worn 
by  them,  under  circumstances  when  it  is  most  necessary, 
is   a  fruitful  source  of  mischief  to  their  health.     In  the 
coldest  of  our  winter  nights,  will  these  fair  devotees  of 
fashion  issue  from  rooms,  heated  to  a  degree  never  expe- 
rienced in  our  hottest  weather,   into  the  chilling  air  of 
midnight,  with  less  clothing  than  they  use  at  noon,  when 
the  sun  exerts  his  greatest  power.     The  next  day  brings 
with  it  "  a  violent  cold,"  and  this  cold  is  too  frequently 
the  foundation  of  the  Consumption  which  destroys  them. 
Occupation  in  life  is  another  source  of  the  ravages  of 
this  disease.     Particular  occupations  subject  those  engaged 
in  them  to  the  respiration  of  air  impregnated  with  foreign 
materials,  irritating  the  lungs,  either  by  their  chemical  or 
mechanical  action.     Substances  acting  mechanically  upon 
the  lungs,  are  inhaled  by  stone-cutters,  millers,  hair-dres- 
sers,  bolters,  coal-heavers,  scythe-grinders,  persons  en- 
gaged in  pointing  needles,  chimney-sweepers,  dressers  of 
flax  and  feathers,  spinners  in  wool,  and  others  employed 
in  similar  occupations.     Chemical  agents  are  taken  into 
the  lungs  by  manufacturers  of  acids,  and  all  other  volatile 


16 

corroding  substances.  These  materials  constantly  acting 
upon  the  lungs,  produce  irritation  and  slight  inflamma- 
tion, terminating  in  Phthisis.  The  operation  of  any  of 
these  causes  is  favoured  when  the  occupation  requires  a 
stooping  or  other  awkward  posture  of  the  body  to  be 
maintained.  This  cause  may  act  independently  of  the 
former  also,  and  hence,  students,  and  clerks  writing  at 
their  desks,  taylors,  shoemakers,  &c.  are  liable  to  this  dis- 
ease. To  the  same  causes  are  frequently  added,  a  seden- 
tary life,  and  confinement  in  hot  rooms ;  hence  "  a  sur- 
geon of  London  whose  opportunities  of  observation  are 
very  extensive,  relates  of  the  gilders  of  that  city,  who 
work  in  heated  rooms,  that  six  out  of  seven  are  said  to  die 
consumptive  in  their  apprenticeship."  Sedentary  habits 
of  life,  accompanied  with  hard  study,  and  too  intense  ap- 
plication of  mind,  predispose  literary  men  to  Consump- 
tion. Loud  public  speaking,  blowing  on  wind  instru- 
ments, glass  blowing  and  other  circumstances  requiring  a 
laborious  and  continued  action  of  the  lungs,  produce  the 
same  effect.  Any  one  of  these  causes  may  frequently 
exist  without  injury,  but  their  combined  action  seldom 
fails  to  produce  pulmonary  disease. 

Climate  was  enumerated  under  the  predisposing  causes 
of  Phthisis.  That  of  our  own  latitude  affords  an  example. 
Its  variableness,  increased  by  contiguity  to  the  ocean, 
together  with  the  prevalence  of  the  moist  and  chilling- 
north-east  winds,  is  probably  the  agent  which  produces 
this  effect.  The  climate  of  Great  Britain  is  not  less  un- 
favourable to  health,  from  similar  causes,  with  the  addi- 


17 

tion  of  its  greater  moisture ;  for  it  is  observed  that  cold 
combined  with  moisture  is  peculiarly  dangerous  to  the 
consumptive.  On  the  other  hand,  inland  countries,  not 
exposed  to  the  moist  winds  from  the  ocean,  are  free  from 
this  disease.  Hence,  the  inhabitants  of  Russia  and  other 
parts  of  the  north  of  Europe,  notwithstanding  the  severity 
of  their  climate,  are  very  little  affected  by  Consumption. 
The  habits  of  the  people,  probably  assist  in  producing 
this  immunity  from  pulmonary  disease.  Sir  John  Sinclair, 
in  a  communication  to  Dr.  Reid,  attributes  it  in  a  great 
measure  to  the  employment  of  furs,  cloaks  and  other 
modes  of  clothing,  which  preserve  an  uniformity  of 
warmth  throughout  the  body  ;  to  the  great  care  taken  by 
all  classes  of  people  to  preserve  their  feet  from  cold  and 
damp  ;  to  the  different  modes  of  communicating  heat  to 
their  apartments;  and  to  the  constant  use  of  the  vapour 
bath.  Similar  observations  were  made  by  Dr.  Cogan, 
who  in  a  letter  to  Dr.  Beddoes,  remarks  that  the  people 
of  Holland  are  exempt  in  a  great  degree  from  this  disease, 
so  prevalent  among  the  English,  and  ascribes  the  difference 
to  the  contrast  observable  between  the  two  countries,  in 
the  construction  of  their  habitations,and  in  the  peculiarities 
of  dress. 

Debility  from  the  want  of  accustomed  stimuli,  is  men- 
tioned by  Dr.  Hosack  as  another  cause  of  consumption, 
and  he  instances  those  confined  in  the  State  Prison.  The 
want  of  accustomed  air  and  exercise,  the  deprivation  of 
the  use  of  spirituous  liquors  and  good  diet,  to  which  the 


18 

prisoners  had  been  accustomed  before  their  confinement, 
was  observed  by  him  to  have  produced  this  disease. 

Depressing  passions  of  the  mind,  and  a.  consequent  too 
free  use  of  spirituous  liquors  have  also  been  noticed  by 
authors  among  the  predisposing  causes  of  Consumption. 

The  last  of  these  causes  which  I  shall  notice,  is  the  dispo- 
sition of  the  system  to  form  calculous  deposits  in  the  lungs, 
generally  in  consequence  of  a  plethoric  habit.  Phthisis 
from  this  cause  however  is  rare  ;  of  nine  hundred  patients 
examined  by  Bayle,  only  four  were  of  this  description. 

These  various  causes  having  either  separately  or  con- 
jointly predisposed  the  body  to  Phthisis,  are  most  fre- 
quently excited  into  action  by  a  common  catarrh  ;  which 
becomes  the  more  active  by  frequent  repetition.  The 
danger  arising  from  catarrh  is  not  a  little  increased  by  the 
popular  mode  of  treating  it :  stimulating  spirituous 
drinks,  and  a  vast  variety  of  remedies  of  the  same  class  are 
the  usual  prescriptions.  Almost  every  body  has  an 
infallible  remedy  for  a  cold  ;  some  of  them  innocent,  but 
many  injurious.  The  common  prejudice  in  favour  of 
"  feeding  a  cold"  increases  the  mischief,  and  unfortunate- 
ly, the  disease  not  generally  affecting  the  system  sufficient- 
ly to  destroy  the  appetite,  as  in  many  other  maladies,  na- 
ture does  not  prevent  the  practice.  Abstinence,  cooling 
acidulous  drinks,  with  perhaps  a  gentle  saline  cathartic, 
are  the  safest  and  most  effectual  remedies  in  curing  a  com- 
mon catarrh,  when  of  its  usual  slight  form.  At  the  same 
time,  inhaling  warm  air,  by  means  of  Mudge's  apparatus, 
is  a  valuable  and  grateful  auxiliary  to  this  treatment.    Ca- 


19 

tarrh  is  so  common  and  generally  so  easily  cured  without 
any  consequent  ill  effects,  that  it  is  too  apt  to  be  neglected. 
Many  a  patient,  labouring  under  incipient  Phthisis,  has 
been  supposed  to  be  affected  by  merely  a  "  trifling  cold,'* 
and  the  only  opportunity  for  curing  the  disease  has  been 
lost.  "  The  evil  becomes  irremediable  before  it  calls  ei- 
ther the  attention  of  the  parents,  the  friends,  or  even  the 
physician,  who  has  not  been  familiarly  conversant  with  the 
fatai  consequences  of  this  disease."6 

Pneumonia  is  not  unfrequently  an  exciting  cause  of 
Phthisis.  Like  catarrh,  its  frequent  repetition  is  more 
dangerous  than  a  single  attack.  Pneumonia  may  indeed 
act  merely  as  a  predisposing  cause  of  Consumption,  by 
leaving  the  lungs  in  a  debilitated  and  irritable  condition, 
favourable  to  the  production  of  that  disease ;  but  it  is  an 
exciting  cause,  when  in  consequence  of  inflammation  of 
the  lungs,  suppuration  follows,  and  vomica  or  empyema 
is  the  consequence.  This  shews  the  close  analogy  be- 
tween Phthisis  Pulmonalis  and  ordinary  Pneumonia.  In 
the  first,  the  inflammation  being  seated  in  the  cellular  and 
comparatively  insensible  portion  of  the  lungs,  is  slow  and 
gradual,  and  the  consequent  suppuration  forms  in  the  same 
manner ;  while  in  Pneumonia,  the  membranous  as  well  as 
cellular  portion  of  the  lungs  being  involved  in  the  disease, 
the  inflammation  is  rapid  and  violent,  and  must  soon  ter- 
minate in  either  resolution  or  suppuration.  Hence 
Phtnisis  Pulmonalis  was  appropriately  called  by  Dr. 
Rush  a  "  Pneumonic ula."     No  word  could  more  accu- 

e  Dr.  Hosack. 


20 

rately  describe  the  nature  of  the  disease.  That  acute  ob- 
server has  drawn  an  excellent  parallel  between  the  two 
diseases,  and  concludes  with  observing,  "  In  short  the 
pneumony  and  Consumption  are  alike  in  so  many  parti- 
culars, that  they  appear  to  resemble  shadows  of  the  same 
substance.  They  differ  only  as  the  protracted  shadow  of 
the  evening  does  from  that  of  the  noon-day  sun."  It  is 
remarked,  however,  that  all  cases  of  Pneumonia  termi- 
nating in  suppuration  are  not  necessarily  fatal.  If  a  pre- 
disposition to  Phthisis  do  not  exist,  or  the  constitution 
be  not  too  much  debilitated,  a  vomica  may  burst  and  be 
discharged,  and  the  patient  recover. 

A  third  exciting  cause  of  Phthisis,  is  the  suppression  of 
accustomed  evacuations.  These  evacuations  are  the  men- 
ses, the  lochiae,  the  discharges  in  Leucorrhaea,  and  from  ul- 
cers, fistulas  and  issues.  Retention  of  the  menses  producing 
Chlorosis,  being  a  consequence  of  debility,  does  not  excite 
primary  Phthisis  Pulmonalis,  but  the  secondary  form  of  the 
disease.  Suppression  of  the  menses,  however,  not  unfre- 
quently  excites  a  Consumption,  bearing  all  the  characters 
and  requiring  the  treatment  of  primary  Phthisis.  Th« 
plethora,  consequent  on  the  cessation  of  the  menses,  has 
often  the  same  effect. 

Asthma,  by  the  constant  irritation  to  which  it  subjects 
the  lungs,  becomes  an  exciting  cause  of  Consumption. 

Several  eruptive  diseases,  as  Scarlatina,  Small-Pox  and 
measles,  often  produce  the  same  disease. 

Morton  also  enumerates  stone  in  the  kidneys  and  blad- 
der, gout  and  rheumatism,  as  causes  of  Consumption. 


21 

By  the  same  author,  contagion  is  supposed  to  commu- 
nicate this  disease.  Morgagni,  Van  Swieten,  Home  and 
Heberden  all  hold  this  opinion.  And  Morgagni  relates 
that  Valsalva,  who  was  predisposed  to  Consumption,  was 
so  satisfied  of  its  contagious  nature,  that  he  constantly 
avoided  being  present  at  the  dissection  of  the  lungs  of 
persons  who  had  died  of  that  disorder. 

Dr.  Rush  maintains  the  same  doctrine,  and  relates  that 
the  late  Dr.  Beardsley  of  Connecticut,  informed  him  that 
he  had  known  several  black  slaves  affected  by  a  Consump- 
tion, which  had  previously  swept  away  several  of  the 
white  members  of  the  family  to  which  they  belonged.  In 
these  slaves  no  suspicion  was  entertained  of  the  most  dis- 
tant relationship  to  the  persons  from  whom  they  had  con- 
tracted the  disease :  nor  had  grief  nor  fatigue,  been  sup- 
posed to  have  had  the  least  share  in  debilitating  their  bo- 
dies. The  force  of  so  much  authority  with  the  evidence 
adduced,  constrains  us  to  admit  the  communicability  of 
Consumption  by  contagion.  But  if  this  agent  has  any  ef- 
fect, its  action  must  be  extremely  limited,  and  extend  no 
farther  than  to  those  previously  predisposed  to  the  disease. 
For  daily  examples  without  number  occur  of  the  constant 
attendants  upon  those  labouring  under  Phthisis  remaining 
perfectly  free  from  that  malady. 

Violence  done  to  the  lungs  by  blows  or  other  injuries 
of  the  chest,  has  in  some  instances,  excited  Consump- 
tion/ 

f  Dr.  Lind  states,  that  out  of  369  patients  whom  he  attended  "between  July  ], 
1758,  and  July  1, 1760,  in  consumption,  the  disease  was  Drought  on  one  fourth  of 


22 

Foreign  bodies  conveyed  accidentally  into  the  lungs 
has  produced  the  same  effect.  Morton  relates  a  curious 
case  where  three  nails  had  passed  into  a  person's  trachea 
and  destroyed  him,  by  inducing  Consumption. 

Bayle  also  enumerates  a  form  of  Phthisis,  which  he 
calls  cancerous,  arising  inpatients  in  whom  the  cancerous 
disposition  has  become  constitutional.  It  is,  however, 
extremely  rare  ;  only  three  cases  having  occurred  to  him 
among  the  900  whom  he  had  examined. 

Haemoptysis  and  tubercles  are  mentioned  by  most  au- 
thors as  exciting  causes  of  Consumption,  and  remain  to 
be  examined.  So  frequently  did  Dr.  Cullen  consider 
Haemoptysis  the  cause  of  Phthisis,  that  he  placed  the  lat- 
ter disease  in  his  Nosology,  merely  as  a  consequence  of 
the  former.  The  impropriety  of  this  arrangement  has 
been  already  touched  upon. 

On  this  subject,  I  would  suggest  the  following  facts. 
Haemoptysis  occurring  in  persons  not  predisposed  to  Con- 
sumption, except  the  quantity  of  blood  lost  be  so  great  as 
to  produce  it  by  mere  debility,  very  frequently  may  be 
easily  cured  without  danger  of  any  consequent  disease. 
Indeed  not  only  in  such  cases  consumption  is  not  induced 
by  it,  but  that  disease  has  actually  been  prevented,  by 
the  occurrence  of  haemorrhage  from  the  lungs,  relieving 
that  inflammation,  which  like  the  inert  physician,  by  with- 
holding the  lancet,  would  have  suffered   to  destroy  his 

them  by  falls,  bruises  and  strains,  received  a  year  or  two  before  it  made  its  ap- 
pearance. 


23 

patient.  Dr.  Rush  relates  two  cases  of  inflammatory  Con- 
sumption  attended  by  a  haemorrhage  of  a  quart  of  blood 
from  the  lungs,  in  which  the  patient  recovered ;  and 
ascribes  their  recovery  entirely  to  the  loss  of  blood. 
Wounds  and  other  injuries  of  the  lungs  frequently  heal, 
when  no  predisposition  to  Phthisis  exists,  as  easily  as  in 
other  parts  of  the  body.  Of  this  fact  also  Dr.  Rush 
affords  an  example.  A  British  officer  informed  him,  a 
few  days  after  the  battle  of  Brandy  wine,  in  September 
1777,  that  the  surgeon  general  of  the  royal  army  had 
assured  him,  that  out  of  twenty  four  soldiers  admitted 
into  the  hospitals,  during  the  campaign  of  1?76,  with 
wounds  of  their  lungs,  twenty-three  recovered.  These 
facts  prove  sufficiently  that  the  constant  motion  of  the 
lungs  does  not  prevent  the  healing  process  taking  place  in 
them  as  easily  as  in  other  parts  of  the  body. 

Inmost  instances,  the  spitting  of  blood  which  is  suppo- 
sed to  have  produced  the  Consumption,  has  occurred  a 
considerable  period  before  the  Phthisical  symptoms  ap- 
peared. During  this  interval  perhaps  the  patient  was 
perfectly  well.  Can  it  be  supposed,  that  the  inflamma- 
tion necessary  to  form  an  ulcer,  and  the  process  of  ulce- 
ration itself,  could  so  long  be  going  on  unperceived,  with- 
out producing  any  irritation  of  the  lungs  r  Is  it  not  more 
probable,  that  the  Haemoptysis  was  recovered  from,  and 
that  the  same  cause  which  produced  it,  at  length  produced 
the  Consumption  ? 

Haemoptysis,  then,  I  would  consider,  as  very  seldom, 
perhaps,  never,  being  the  cause  of  Consumption;  but  in 


24 

all  those  cases  in  which  it  is  assigned  as  the  cause,  merely 
a  symptom  of  the  incipient  stage  of  the  disease.  The 
symptoms  accompanying  haemorrhage  from  the  lungs,  are 
no  other  than  those  of  incipient  Phthisis.  They  are  thus 
accurately  described  by  Dr.  Reid.  "  When  subsequent 
to  a  sense  of  weight  and  oppression  in  the  breast,  which 
scarcely  amounts  to  a  feeling  of  pain,  together  with  cough, 
difficult  respiration,  and  general  lassitude,  a  quantity  of 
blood  is  suddenly,  and  in  a  convulsive  manner,  dischar- 
ged from  the  mouth,  there  can  remain  small  doubt  res- 
pecting the  part  from  which  it  proceeds.  If  the  dischar- 
ged blood  be  of  a  florid  colour,  and  together  with  the 
above  symptoms,  a  saltish  taste  be  perceived  in  the 
mouth,  and  the  patient  become  sensible  of  a  degree  of  irri- 
tation in  the  upper  part  of  the  trachea,  the  nature  of  the 
affection  is  rendered  altogether  unequivocal."  Every 
symptom  here  enumerated,  occurs  in  the  early  periods  of 
Consumption. 

Nor  have  we  any  better  reason  for  believing  tubercles 
to  be  an  exciting  cause  of  Phthisis.  These  appearances 
are  indeed  very  frequently  found  in  dissections  of  the  lungs 
of  those  who  have  died  of  Consumption.  Of  the  nine  hun- 
dred patients  examined  by  Bayle,  624  had  tuberculated 
lungs.  Tubercles  were  formerly  considered  as  indurated 
glands,  and  generally  attributed  to  a  scrophulous  constitu- 
tion ;  but  we  are  assured  by  Baillie,  in  his  morbid  Anato- 
my, "  that  there  is  no  glandular  structure  in  the  cellular 
connecting  membrane  of  the  lungs ;  and  on  the  inside  of 
the  branches  of  the  trachea,  where  there  are  follicles,  tu- 


25 

bercles  have  never  been  seen."  These  tubercles  are 
roundish  bodies,  of  a  firm  consistence,  and  frequently  a 
cartilaginous  structure,  but  often  containing  decidedly 
purulent  matter.  By  the  union  of  several  of  them,  vomi- 
cae are  formed,  which  are  only  larger  tubercles.  May 
not  the  formation  of  these  bodies  be  sufficiently  account- 
ed for  by  the  preceding  inflammation,  and  they  be  con- 
sidered therefore  a  consequence,  rather  than  a  cause  of 
Consumption?  Dr.  Rush  insists  that  tubercles  are  the 
effects,  and  not  the  cause  of  pulmonary  Consumption  ;  and 
remarks  as  a  farther  evidence  of  this  opinion,  that  simi- 
lar tumours  are  suddenly  formed  on  the  intestines  by 
dysentary,  and  on  the  omentum  by  a  yellow  fever.  He 
refers  to  cases  of  the  former  in  the  dissections  of  Sir  John 
Pringle,  and  one  of  the  latter  mentioned  by  Dr.  Mackit- 
trick,  in  his  inaugural  dissertation  on  the  yellow  fever, 
published  in  Edinburgh, in  the  year  1776.  Dr.  Hosack, 
in  his  Lectures  on  the  Theory  and  Practice  of  Physic, 
advocates  the  same  doctrine,  and  enforces  it,  by  remark- 
ing, that  similar  tubercles  are  formed  in  the  parenchyma 
of  the  brain,  the  liver,  and  the  kidneys,  in  which  no  small 
glands  have  yet  been  detected,  and  where,  as  in  the 
lungs,  there  is  nothing  but  cellular  membrane  and  ves- 
sels. It  is  his  opinion,  that  it  is  an  union  of  a  number 
of  these  cells  in  a  state  of  congestion  that  constitutes 
tubercles  or  vomicae — that  in  some  instances  they  heal, 
the  matter  is  absorbed,  and  they  remain  in  a  scirrhous 
state,  the  patient  becoming  perfectly  restored  to  health  : 

D 


26 

and  hence  the  remark  of  Dr.  Simmons,  that  tubercles 
may  exist  without  Phthisis. 

These  are  all  the  principal  predisposing  and  exciting 
causes  of  Phthisis  Pulmonalis.  Some  few  others  are  men- 
tioned by  authors,  but  they  are  of  either  very  doubtful 
agency,  or  too  rare  to  deserve  notice. 

The  disease  having  been  excited  into  action,  produces 
a  succession  of  symptoms  which  are  now  to  be  detailed. 
Its  attack  is  frequently  extremely  insidious  and  slow ;  at 
other  times,  well  marked  and  rapid  in  its  progress.  It  is 
to  this  insidious  and  gradual  mode  of  attack,  that  Con- 
sumption owes  much  of  its  fatal  character.  Before  the 
unfortunate  patient  suspects  himself  to  be  seriously  in- 
disposed, it  but  too  frequently  happens,  that  his  fate  is 
sealed,  and  death  is  inevitable.  This  arrives  in  part  from 
the  resemblance  that  Incipient  Phthisis  bears  to  a  long 
continued  catarrh.  It  frequently  is  only  marked  in  its 
earliest  periods  by  a  slight,  dry,  hacking  cough,  trivial 
during  the  day,  increased  at  evening,  and  most  trouble- 
some at  night;  a  sense  of  weight  about  the  breast,  and 
some  little  difficulty  of  breathing,  increased  on  taking 
any  unusual  exercise,  or  ascending  a  height;  the  pulse 
is  slightly  accelerated,  and  sometimes  only  so  after  taking 
food:  occasionally,  burning  hands  and  feet,  and  a  slight 
flush  in  the  cheek  are  the  only  symptoms  of  fever.  These 
symptoms  may  be  so  slight  as  hardly  to  attract  the 
patient's  notice  ;  at  other  times  they  are  more  severe 
and  distressing.  Frequently,  on  any  little  unusual  exer- 
cise, the  cough  is  increased,  the  patient  feels  a  pain  in 


27 

the  side,  and  expectorates  a  frothy  mucus,  and  blood  is 
discharged  from  the  lungs.  This,  perhaps,  is  the  first 
symptom  which  excites  the  alarm  of  the  patient.  Ex- 
pectoration of  blood  is  generally  preceded  by  a  saltish 
taste  in  the  mouth,  and  a  sense  of  irritation  at  the  up- 
per part  of  the  trachea..  It  is  known  to  come  from 
the  lungs  and  not  the  stomach,  by  its  frothy  appearance 
and  admixture  with  mucus,  while  that  from  the  stomach 
is  generally  dark  coloured  and  mixed  with  the  food  ;  and 
by  being  brought  up  by  coughing  and  not  vomiting. 
The  blood  coming  from  the  stomach  too,  is  generally  in, 
larger  quantity  than  that  from  the  lungs. 

In  addition  to  these  symptoms,  the  patient  is  often 
affected  by  an  increased  sensibility  of  the  lungs,  obser- 
vable on  any  exposure  to  cold,  change  of  dress,  or  go- 
ing from  a  warm  to  a  cool  apartment.  There  is  a  sense 
of  soreness  in  the  lungs  attended  with  a  sensation  of 
stricture  about  the  chest.  Pain  is  felt  in  the  side  or 
breast,  and  the  patient  lies  with  difficulty  on  the  side 
affected.  The  pain  is  frequently  lancinating,  and  shoot- 
ing through  the  breast,  sometimes  in  the  direction  of  the 
mediastinum,  at  others,  confined  to  one  side. 

As  the  disease  advances,  the  symptoms  of  fever  be- 
come more  marked.  The  tongue  is  diy,  attended  with 
thirst,  loss  of  appetite,  nausea,  and  occasional  vomiting, 
and  a  desire  for  acids.  The  secretions  generally  are 
checked.  Perspiration  is  diminished,  and  the  skin  rs-hot 
and  dry.  The  urine  is  at  first  diminished  in  quantity, 
and  high  coloured.     The  menses,   in  females,  are  either 


28 

suppressed  or  very  irregular.  The  bowels  are  frequent- 
ly costive.  The  patient  passes  restless  nights,  and  is 
prevented  sleeping  by  a  tormenting  cough,  or  if  he 
sleeps,  is  troubled  with  dreams.  In  consequence  of  in- 
digestion, pain  is  felt  in  the  situation  of  the  stomach,  at- 
tended with  flatulence.  The  patient  begins  to  have  a 
pallid  countenance,  and  emaciation  gradually  takes 
place. 

These  symptoms  may  continue  a  length  of  time,  gra- 
dually debilitating  the  patient.     But  the  expectoration 
which  at  first  was  frothy,  in  small  quantity,  and  coughed 
up    with    difficulty    and  pain,  increases,  and  gradually 
passing  through  all  the  stages  between  mucus  and  pus, 
at  length  becomes  decidedly  purulent.     A  new  train  of 
symptoms  follow.     Hectic  fever  makes  its  appearance, 
commencing   with  irregular  cold  and  shivering  fits,  re- 
turning frequently   during  the  day.     It  soon,  however, 
assumes  a  decided  character,  and  has  two  marked  ex- 
acerbations, the  one  at  noon,  the  other  at  night.     These 
exacerbations  begin  with  a  sense  of  coldness,  succeeded 
by  heat,  and  at  night  terminating  in  profuse  perspira- 
tion.    During  the  chill  and  hot  fit,  the  cough,  pain,  and 
dyspnoea  are  aggravated,  but  relieved  by  the  sweating. 
The  pulse  before  the  paroxysm  is  accelerated  and  weak, 
during  its  continuance  quick  and  strong,  but  abates  as 
the  perspiration  flows.     The   countenance  is   generally 
pale,  but  during  the  exacerbation  is   marked  by  a  cir- 
cumscribed crimson  flush,  which  occurs  mostly  at  noon, 
hut  may  be  produced  by  taking  food  or  any  other  cause 


29 

of  excitement  The  profuse  sweats  do  not  occur  after 
the  exacerbation  at  noon,  but  in  the  morning,  while  the 
patient  is  warm  in  bed,  with  the  system  relaxed  by 
sleep.  The  perspiration  is  principally  confined  to  the 
superior  parts  of  the  body,  as  the  neck,  breast,  and 
about,  the  shoulders.  The  tongue  is  often  very  clean 
during  hectic  fever,  but  sometimes  furred.  The  bowels 
are  generally  torpid,  alternating  with  diarrhoea. 

The  disease  continuing  to  advance,  the  cough  and 
dyspnsea  increase,  and  the  hectic  symptoms  become  more 
marked  and  violent.  Emaciation  rapidly  goes  on,  the 
face  looks  sharp  and  haggard,  and  the  absorption  of  fat 
makes  the  e}^es  appear  remarkably  large  and  prominent. 
At  the  same  time,  the  teeth  appear  unusually  white  and 
beautiful.  The  appetite  becomes  extremely  irregular, 
the  pulse  more  accelerated  and  diminished  in  strength. 
The  mind  is  extremely  vacillating,  at  one  time  depres- 
sed, at  another,  elated  with  hopes  of  recovery.  Profuse 
diarrhoeas,  alternated  with  obstinate  torpor  of  the  bowels, 
exhaust  the  patient;  the  eyes  assume  a  ghastly  and 
pearly  whiteness  ;  the  mouth  becomes  filled  with  apthous 
eruptions ;  sometimes  hiccup  ensues  ;  the  patient's  mind 
becoming  more  and  more  disturbed,  delirium  comes  on, 
which  soon  terminates  in  death. 

An  assemblage  of  some  or  all  these  symptoms,  con- 
stitutes Phthisis  Pulmonalis,  differing  however  very  ma- 
terially in  number,  degree  and  violence  in  different  pa- 
tients. They  are  variously  modified  by  a  number  of  at- 
tending circumstances,  which  require  some  attention. 


30 

Many  authors  declare,  that  an  expectoration  of  pus" 
does  not  always  attend  this  disease.  The  matter  may  be 
confined  in  a  vomica,  and  the  patient  die  with  the  symp- 
toms of  Phthisis  before  it  bursts.  Nor  does  a  purulent 
expectoration  necessarily  indicate  the  existence  of  an 
ulcer  in  the  lungs.  The  matter  may  be  poured  out  from 
the  secreting  surfaces  of  the  lungs  without  ulceration, 
precisely  as  it  comes  from  the  adnata  of  the  eye  after 
opthalmia,  or  the  urethra  in  gonorrhoea,  where  no  ulcer 
is  suspected.  In  the  New-York  hospital,  dissections  of 
numerous  patients  who  have  died  of  Phthisis,  sufficiently 
prove  the  fact  in  question. 

Nor  does  pain  in  the  side  or  breast,  always  accompany 
this  disease.  Dr.  Reid  remarks  that  many  cases  have 
occurred  in  his  practice,  where  no  pain  in  any  part  of  the 
chest  has  been  observed  during  the  whole  course  of  the 
disorder.  "  I  have  witnessed,"  says  Dr.  Heberden, 
"  many  deaths  from  genuine  pulmonary  consumption, 
where  dissection  has  demonstrated  an  entire  destruction 
of  the  substance  of  the  lungs,  and  where  through  the 
w-ioie  course  of  the  disease,  neither  expectoration  of 
blood,  difficulty  of  breathing,  nor  pain  in  the  side  had 
been  present."  On  the  other  hand,  pain  in  the  side  may- 
occur  merely  as  a  consequence  of  the  debilitated  or  irre- 
gular action  of  the  muscles,  as  in  walking,  and  should  not 
be  mistaken  for  a  symptom  of  Consumption. 

In  the  course  of  the  disease,  dropsical  effusions,  con- 
stituting Ascites,   Hydrothorax    and   Anasarca,  are  not 


31 

unusual,  as  in  other  diseases  where  great  debility  is  pro- 
duced. 

In  the  advanced  periods  of  Consumption,  diarrhoea 
constitutes  a  prominent  and  troublesome  symptom.  This 
is  sometimes  produced  by  any  cause  which  checks  the 
profuse  sweats;  while  on  the  other  hand,  if  the  diarrhoea 
be  checked,  the  cough  and  dyspnoea,  which  perhaps  had 
been  relieved  by  it,  frequently  return  with  redoubled 
violence.  Under  these  circumstances,  the  condition  of 
the  patient  is  hopeless  indeed. 

The  approach  of  summer  frequently  mitigates  the 
sufferings  of  the  consumptive,  and  gives  them  hopes  of 
returning  health;  but  when  winter  returns,  these  hapes 
are  blasted ;  the  patient  sinks  again  into  his  former 
condition,  and  most  generally  is  cut  off  during  the  cold 
season. 

The  symptoms  of  Phthisis  are  frequently  suspended 
or  mitigated  by  any  cause  producing  a  new  determination 
in  the  system.  The  most  prominent  of  these  causes  is 
pregnancy.  It  almost  invariably  happens  that  the  symp- 
toms of  Consumption  are  relieved  by  the  occurrence  of 
this  event ;  but  after  parturition  the  disease  returns  with 
all  its  former  violence.  The  occurrence  of  mania  has 
produced  the  same  effect,  and  has  even  entirely  cured 
the  disease ;  but  generally,  when  the  mania  is  removed, 
the  symptoms  of  Consumption  return.  An  attack  of 
rheumatism  has  frequently  relieved  phthisical  complaints. 
Dr.  Rush  refers  to  three  clinical  patients  in  the  hospital  of 
Pennsylvania  to  exemplify  this  observation.     In  the  same 


32 

maimer  gout  is  observed  to  alternate  with  Consumption, 
and  during  its  paroxysms,  the  complaint  of  the  lungs  is 
relieved.  Frequent  cases  are  related,  in  works  on  this 
subject,  of  eruptions  on  the  skin  alternating  with  Phthisis 
Pulmonalis. 

Long  continued  ulcers,  or  fistulas  in  ano  not  unfre- 
quently  relieve  pulmonic  complaints  in  phthisical  patients ; 
while  the  healing  of  these  ulcers  or  fistulas  reproduces  the 
disease  with  tenfold  violence. 

A  farther  circumstance  worthy  of  remark  in  this  dis- 
ease is,  the  willingness  with  which  the  patient  suffers 
himself  to  be  flattered  with  hopes  of  recovery.  Notwith- 
standing he  sees  daily  victims  of  Consumption  falling 
around  him ;  notwithstanding  the  perfect  assurance  he 
has  of  the  small  number  of  those  who  recover  from  it ; 
to  the  last  his  hopes  are  not  abandoned.  Although  de- 
pressed at  night  by  the  evening  exacerbation  of  hectic  fe- 
ver; in  the  morning,  from  his  comparatively  comfortable 
situation,  his  hopes  revive.  Happy  is  it  for  these  misera- 
ble sufferers  that  they  do  not  despair.  In  a  disease  whose 
progress  is  frequently  so  slow,  and  whose  event  is  but  too 
often  so  sure,  fortunate  it  is,  that  a  solace  remains  to  cheer 
the  unhappy  patient. 

The  duration  of  Consumption  is  extremely  various  ; 
from  a  few  weeks  to  fifty  years  have  patients  laboured 
under  it.  In  Bayle's  statement  of  the  duration  of  the 
disease  in  two  hundred  cases  in  which  the  patients  were 
destroyed  by  it,  it  was  between  two  months  and  two  years 


33 

in  168  cases,  four  were  less  than  two  months,  and  2S  re- 
mained more  than  two  years. 

From  the  detail  of  symptoms  which  has  just  been 
given,  it  is  evident,  that  there  are  two  distinct  stages  of 
Phthisis  Pulmonalis,  each  characterised  by  peculiar  symp- 
toms, and  requiring  peculiar  treatment.  The  first,  inci- 
pient, or  acute  stage  as  it  is  variously  termed  by  au- 
thors, is  the  stage  of  inflammation,  and  terminates  as 
soon  as  purulent  expectoration  and  hectic  fever  com- 
mence. The  second,  confirmed,  or  chronic  stage  com- 
mences where  the  first  terminates,  and  ends  most  gen- 
erally in  death.  We  would  not  however  assert,  that 
these  stages  can  always  be  accurately  distinguished,  and 
a  line  drawn  between  them.  On  the  contrary,  hectic 
fever  may  occur  early  in  the  disease,  before  any  expec- 
toration of  pus  takes  place,  and  inflammatory  symptoms 
frequently  attend  its  advanced  stage.  In  general,  the 
-distinction  can  be  made,  and  must  necessarily  guide  the 
prudent  physician. 

Having  taken  a  view  of  the  causes  and  symptoms  of 
Phthisis  Pulmonalis,  w^e  are  now  prepared  to  investi- 
gate the  proximate  cause  of  the  disease.  From  the  na- 
ture and  extent  of  these  symptoms,  it  appears  evident- 
ly a  disease  of  the  whole  system,  and  not  confined 
merely  to  the  lungs.  The  proximate  cause,  as  taught 
by  Dr.  Hosack,  in  his  lectures,  is,  an  inflammation  of 
the  lungs,  terminating  either  in  a  purulent  secretion,  or 
ulceration  in    their  substance.     This    opinion   is  much 

strengthened  bv  the  analogy  before  remarked  between 

E 


34 

Phthisis  Pulmonalis  and  Pneumonia.     It  is  a  little  6hv 
gular  that  Dr.  Rush,  notwithstanding  he  had  remarked 
this   close  analogy,  and   although  he  speaks  of  inflam- 
matory   fever  as   a  part  of  the  disease,  and  prescribes 
blood-letting  in  its  treatment,  should  yet  have  made  de- 
bility its   proximate  cause.     This  is  only  one  instance 
among  many,  of  physicians  arriving  at  precisely  the  same 
modes  of  treatment  by  directly  opposite  routes.     If  that 
theory  of  inflammation  be  admitted,  which  makes  de- 
bility its  cause,  so  far  it  is  also  the  proximate  cause  of 
Phthisis  Pulmonalis.  In  the  secondary  species  of  Phthisis, 
hereafter  to  be  considered,  debility  may  be  fairly  ranked 
as  the  proximate  cause,  and  the  indications  of  cure  cor- 
rectly drawn  from  it.     But  in  the  primary  disease  under 
consideration,  if  we  were   to  found  our  indications  on 
this  basis,  and  thence  deduce  the  propriety  of  exhibiting 
powerful   tonics  in  the  first  stage  of  the  disease,  when 
brought  to  the  test  of  practice,  its  error  would  soon  be- 
come sufficiently  glaring, 

Various  other  causes  have  been  successively  treated  of 
by  authors,  but  to  shew  their  inconsistency  and  absurdi- 
ty, it  is  only  necessary  to  observe  that,  "  the  existence 
of  an  acid  or  an  alkali,  of  chemical  acrimony,  or  mecha- 
nical changes  in  the  blood,  of  corroding  volatile  parti- 
cles, and  even  of  animalcula  in  the  lungs,  have  been 
vaguely  conjectured  to  be  the  cause  of  pulmonary  ulcer 
and  hectic  fever.s" 

8  Dr.  Reid. 


35 

Assuming  then,  inflammation  of  the  lungs,  and  con- 
sequent ulceration  of  their  substance  as  the  proximate 
cause  of  Phthisis  Pulmonalis,  we  naturally  deduce  the 
following  indications  in  the  treatment  of  the  disease. 

1.  To  endeavour  to  relieve  the  inflammation  of  the 
lungs,  and  promote  its  resolution. 

2.  If,  notwithstanding  all  our  efforts,  suppuration 
takes  place,  to  give  sufficient  support  and  tone  to  the  sys- 
tem to  enable  the  ulcers  to  heal. 

In  fulfilling  these  indications,  our  first  object  is  to  re- 
move the  remote  causes,  where  it  is  possible.  If  the  pa- 
tient's occupation  is  one  of  those  which  predisposes  to 
Consumption,  unless  it  be  abandoned,  or  at  least  so  mo- 
dified as  to  correct  the  objectionable  parts  of  it,  we  can- 
not hope  to  cure  the  disease.  If  the  disease  arise  from 
the  suppression  of  an  accustomed  evacuation,  our  ut- 
most endeavours  must  be  made  to  restore  it.  Should 
suppression  of  the  menses  be  the  cause,  means  calculated 
to  produce  their  return  must  be  resorted  to.  If  an  ulcer 
or  fistula  has  healed  up,  they  must  be  re-opened,  or  is- 
sues established  in  more  convenient  situations.  In  short, 
the  rule  is  plain  and  simple.  Remove  the  remote  cau- 
ses, wherever  it  is  practicable. 

Among  the  remedies  which  are  necessary  to  fulfil 
the  first  indication,  the  most  prominent  is  Blood-letting, 
This  remedy  has  been  strongly  advocated  by  many  of 
the  most  distinguished  authors  who  have  written  on 
Consumption;  and  its  propriety  admitted  by  all  under 
certain  circumstances,    Probably,  most  of  the  injurious 


36 

effects  attributed  to  it,  may  be  accounted  for  by  a  proper 
distinction  not  having  been  made  between  Primary  and 
Secondary  Phthisis  Pulmonalis.  When  bleeding  has  been 
practised  in  the  secondary  form  of  the  disease,  it  has  been 
generally  injurious,  and  hence  an  odium  has  been  cast 
upon  its  employment  in  any  circumstances.  In  the  same 
manner,  it  has  done  mischief,  when  used  too  late  in 
Primary  Phthisis,  and  thus  another  groundless  argument 
furnished  against  the  remedy.  But  the  indiscriminate 
use  of  blood-letting  is  not  here  contended  for.  Its  ju- 
dicious and  cautious  use,  when  inflammatory  action  is 
evident,  alone  is  intended  to  be  advocated.  On  the  other 
hand,  too  timid  practice  may  induce  u&  to  withhold  the 
lancet  when  it  is  necessary  ;  and  we  may  thus  do  as 
much  injury  by  losing  the  proper  time  for  action,  a& 
we  would  have  done  by  pushing  the  remedy  too  far. 
It  is  dim  cult  to  fix  the  period  beyond  which  it  is  im- 
proper to  bleed  in  Consumption,  Dr.  Hosack  insists 
that  as  long  as  there  is  any  pain  or  soreness  on  taking  a 
full  inspiration,  the  lancet  is  necessary.  This  rule  is  not 
applicable  to  practice ;  for  if  we  adopt  it,  we  may  bleed 
the  patient  until  he  dies.  Until  that  moment  will  the 
pain  in  some  instances  continue.  It  is  not  unfrequent,. 
after  the  patient  has  been  exhausted  by  colliquative 
sweats,  and  profuse  diarrhoea,  for  pain  in  the  breast  to 
recur  at  intervals,  a  few  days  before  death:  and  what 
practitioner,  under  such  circumstances,  would  feel  him- 
self justified  in  using  the  lancet?  But  this  rule  is  incor- 
rect in  another  point  of  view.     In  some  cases,    it  will 


37 

prevent  our  using  this  valuable  remedy,  when  it  is  ne~ 
eessary.  On  the  authority  of  Dr.  Reid,  it  is  asserted, 
that  pain  is  not  always  present  in  Phthisis  Pulmonalis ; 
and  may  not  occur  during  the  whole  course  of  the  dis- 
ease. A  reference  has  been  already  made  to  Dr.  Heber- 
den  to  prove  the  same  fact.  On  this  subject  it  is  impos- 
sible to  fix  any  precise  rule;  The  strength  and  habit 
of  the  patient,  the  urgency  of  the  symptoms,  and  state  of 
the  pulse,  must  all  be  recollected  and  adverted  to  in  ma- 
king up  our  judgment  as  to  the  propriety  of  the  remedy. 
In  general,  perhaps  we  may  say,  that  after  the  formation 
of  matter  is  perfectly  ascertained,  it  is  improper  to  bleed. 
This,  however,  is  not  without  exceptions.  Cases  some- 
times occur,  after  this  period,  in  which  the  symptoms 
of  high  inflammatory  action  arise,  and  where  the  lancet 
is  indicated.  It  is  now  generally  admitted  that  the  buffy 
appearance  of  the  blood  is  by  no  means  an  infallible  evi- 
dence of  the  necessity  of  the  repetition  of  blood-letting. 
Nor  is  its  cupped  form  a  better  proof  of  the  existence 
of  inflammation.  Many  writers  have  observed,  that 
the  burly  coat  appears-  in  the  blood  drawn  in  Consump- 
tion at  the  latest  periods  of  the  disease.  A  remarkable 
and  decided  case  of  Enteritis,  occurred  during  the  last 
winter,  in  the  New- York  Hospital,  in  which  very  large 
and  repeated  bleedings  were  made  use  of,  with  the  good 
effect  of  curing  the  patient :  and  yet,  neither  buff  nor 
the  cuplike  form  appeared  in  the  smallest  degree  in  the 
blood  drawn.  This  case  alone  is  sufficient  to  prove, 
how   equivocal  are  these  appearances  of  the   bloody  as 


33 

tests  of  inflammation.  Nevertheless,  the  judicious  prac- 
titioner will  not  fail  to  observe  these  circumstances,  and 
as  they  so  frequently  accompany  inflammation,  will  con- 
sider them,  when  attended  with  other  evidences,  as 
properly  influencing  his  judgment  on  the  propriety  of 
bleeding. 

If  the  abstraction  of  blood  from  the  system  generally 
is  useful,  no  less  so  is  it  when  drawn  from  the  part 
itself,  by  the  application  of  cupping-glasses,  and  the 
scarificator  to  the  chest.  This  mode  of  obtaining  blood 
is  peculiarly  useful  in  those  frequent  cases,  where  the 
patient  is  too  much  debilitated  to  bear  the  loss  of  much 
blood,  but  the  existence  of  inflammatory  action  makes  its 
abstraction  necessary. 

Emetics  are  a  powerful  remedy  in  the  treatment  of 
Phthisis.  They  not  only  promote  expectoration,  and  re- 
lieve the  distressing  cough  in  the  first  stage  of  the  disease, 
but  by  their  general  relaxing  effects  upon  the  system, 
are  useful  in  reducing  inflammatory  action.  The  use 
of  this  remedy,  however,  should  not  in  general  be  com- 
menced until  blood-letting  has  been  premised ;  other- 
wise in  plethoric  habits,  full  vomiting  might  induce 
haemoptysis.  Practitioners  have  differed  very  much  in 
the  choice  of  emetics  proper  in  this  disease.  The  an- 
timonial  preparations  and  ipecacuanha,  as  acting  more 
generally  upon  the  system  in  reducing  excitement,  and 
from  their  good  effects  in  other  febrile  diseases,  appear 
to  be  the  most  proper.  But  in  tl^e  last  stage  of  Con- 
sumption, where  our  object  is  to  relieve  the  pulmon- 


33 

aty    symptoms,    without   debilitating    the    patient,  the 
sulphates  of  zinc  and  copper  are  preferable. 

Emetics  are  not  only  useful  when  exhibited  for  the 
purpose  of  full  vomiting,  but  medicines  of  the  same 
class  given  as  diaphorectics  are  also  proper.  With  this 
view  the  various  preparations  of  antimony  are  in  use. 
Small  doses  of  the  Antimonial  powder  combined  with 
calomel  have  been  found,  perhaps,  one  of  the  best  su- 
dorifics  that  can  be  employed,  and  as  such  are  frequently 
useful  in  Phthisis.  No  medicine  is  superior  to  this 
combination  in  reducing  inflammatory  action ;  and  ii 
frequently  has  a  better  effect  by  proving  both  emetic 
and  purgative. 

As  a  sudorific,  warm  bathing  may  be  very  useful,  and 
is  an  agreeable  remedy  in  the  inflammatory  stage  of 
Phthisis.  As  the  warm  bath  is  useful  in  relaxing  the 
surface  of  the  body  generally  ;  in  a  similar  manner  in- 
haling warm  air,  by  means  of  Mudge's  apparatus,  re- 
laxes the  inflamed  membrane  of  the  bronchiae,  and 
acts  as  a  fomentation  there,  with  the  same  good  effect 
as  is  produced  by  warmth  and  moisture  upon  any  other 
inflamed  surface  of  the  body.  This  remedy  gives  great 
relief  in  the  cough  and  hoarseness  so  distressing  in  Phthisis 
Pulmonalis. 

With  the  same  view  of  counteracting  inflammation- 
cathartics  may  be  prescribed.  As  in  other  febrile  dis- 
eases, so  in  Phthisis,  the  bowels  are  frequently  torpid, 
and  require  the  frequent  use  of  aperient  medicines.  Sa- 
line and  mercurial   cathartics,  possessing  the   greatest 


40 

power  in  diminishing  excitement,  are  perhaps  the  most 
proper  in  this  disease.  But  as  it  is  an  object  not  to  in- 
duce too  much  debility,  the  use  of  drastic  purgatives 
should  be  avoided  as  much  as  possible,  and  be  confined 
to  the  earliest  periods  of  the  disease.  During  its  ad- 
vanced stage,  the  bowels  should  be  kept  open  by  mild 
laxatives  and  enemata,  which  tend  least  to  debilitate  the 
patient. 

Blisters,  Setons  and  Issues  relieve  the  inflammation  of 
the  lungs,  and  produce  a  new  determination  to- the  sur- 
face with  the  happiest  effects.  Most  writers  agree  in 
recommending  repeated  blisters  to  the  chest,  as  an  useful 
remedy,  and  with  reason.  But  it  is  to  be  regretted  that 
they  have  been  suffered  to  usurp  the  place  of  a  more 
powerful  remedy  of  the  same  class,  viz.  Issues.  If  we 
may  judge  from;  the  effect  of  ulcers  and  fistulas,  which 
palliate  all  the  symptoms  of  confirmed  Phthisis,  while 
they  continue,  but  whose  healing  restores  the  disease,  it 
would  appear  that  the  establishment  of  similar  drains,  in 
the  form  of  issues,  ought  to  have  a  good  effect.  In  ca- 
ries of  the  spine,  and  disease  of  the  hip  joint,  where 
the  inflammation  in  the  cellular  structure  of  the  bones 
seems  to  be  very  analagous  to  that  in  the  cells  of  the 
lungs,  issues  are  used  with  the  greatest  benefit.  In  these 
cases,  they  are  uniformly  preferred  to  repeated  blister- 
ing, and  experience  has  sanctioned  the  preference.  Issues 
are  preferable  to  blisters  by  their  constant  and  uniform 
action,  whereas  the  latter  remedy  has  its  effect  continu- 
ally interrupted  by  healing  up  and  requiring  renewal. 


41 

fn  general,  blisters  appear  to  be  more  useful  in  acute  dis«* 
eases,  which    may    soon  be  subdued  :  but    in    Phthisis 
Pulmonaiis,  which  continues  so  long,   and    whose  pro- 
gress is  so  slow,  issues  appear  to  be  the  better  remedy, 
Dr.  Mudge  was  so  well  convinced  of  their  efficacy,  that 
he  assures   us,  he   cured   himself  of  an   Incipient  Con- 
sumption, by  a  large  issue  between  the  shoulders.     Bed- 
does  also  recommends  them,  and   relates  several    cases, 
in  which  they  were   used  with  the  best  effect.     But  if 
this  remedy  be  tried,  it  should  not  be  done  timidly,  and 
with   the  fear  of  giving  pain  ;  when  used  at  all,  issues 
should  be  large  and  effectual,  not  only  sufficient  to  con- 
tain a  single  pea,  but  at  least  a  dozen.     This  is  not  the 
only  remedy  which  has  fallen  into  disrepute  by  a  trifling 
and  inefficient  mode  of  employing  it.     But  as  blisters  are 
preferred  by  many  of  the  most  judicious  practitioners, 
their  use  may   easily  and  with   advantage   be  combined 
with  that  of  issues.     While  a  large  issue  is  kept  open 
between   the  shoulders,  successive   blisters   may  be  ap- 
plied to  the  chest.     Many  patients,  perhaps,  would  not 
submit  to  so  severe  a  mode  of  treatment ;  but  it  is  only 
by  such  active  and  efficient  practice,  that  we  can  hope  to 
cure  this  formidable  malady. 

It  is  only  in  the  first  stage  of  Consumption  that  much 
benefit  is  to  be  expected  from  this  class  of  remedies, 
or  at  all  events,  before  the  patient  is  much  debilitated. 
In  its  latest  periods,  they  would  tend  rather  to  add  to 
the    debility     already    induced    by    the    disease.      Af 


42 

any  time,  however,  when  the  patient  is    not  too  much 
reduced,  they  may  be  prescribed  with  advantage. 

Mercury,  given  until  it  produce  salivation  has  fre- 
quently cured  Phthisis  Pulmonalis.  It  is  used  with 
greatest  advantage  in  its  first  stage,  but  after  the  in- 
flammatory action  has  been  in  some  measure  reduced, 
by  means  of  blood-letting,  and  the  other  remedies  pro- 
posed. Before  these  evacuations  have  been  premised, 
it  would  tend  rather  to  increase  the  inflammation ;  while 
in  the  advanced  stage  it  would  add  too  much  to  the 
debility  of  the  patient.  It  generally  succeeds  only  when 
it  affects  the  mouth,  and  therefore  to  secure  this  effect 
and  prevent  its  running  off  by  the  bowels,  it  should  be 
combined  with  opium.  But  the  best  form  of  exhibiting 
mercury,  is  one  much  in  use  with  my  worthy  friend  and 
preceptor,  Dr.  Borrowe.  Calomel,  combined  with  small 
doses  of  antimonial  powder,  given  morning  and  evening, 
until  it  affect  the  mouth,  is  the  form  proposed.  In  this 
way  it  may  be  given  at  an  earlier  period  of  the  disease, 
than  would  otherwise  be  proper,  by  the  constant  deter- 
mination to  the  skin  kept  up  by  the  antimonial  powder, 
obviating  the  tendency  which  mercury  has  to  increase 
inflammatory  action.  At  the  same  time  it  serves  to  keep 
the  bowels  open,  and  makes  almost  every  other  medicine 
unnecessary.  On  the  other  hand,  if  it  acts  too  much  on 
the  bowels,  it  may  be  usefully  combined  with  opium , 
which  adds  to  its  diaphoretic  effect.  The  good  effects  of 
this  mode  of  exhibiting  mercury,  is  strikingly  illustrated 
by  the  result  of  the  following  case,  which  occurred  in 


43 

"the  practice  of  Dr.  Borrowe  within  a  few  months 
past. 

"Miss  -^— ,  aged  about  14  years,  had  been  for  six 

months  past,  afflicted  with  some  cough,  pain  in  the 
chest  and  difficulty  of  breathing.  She  was  affected  with 
loss  of  appetite,  emaciation  and  profuse  sweats  at  night. 
Her  pulses  were  frequent;  she  had  the  peculiar  pearl- 
like  appearance  of  the  adnata;  frequent  attacks  of  di- 
arrhcea,  and  an  expectoration  much  resembling  pus. 
She  was  attacked  with  chills  about  the  middle  of  the 
day,  followed  by  considerable  excitement,  aversion  to 
motion  and  drowsiness  ;  succeeded  by  great  prostration 
of  strength  ;  palpitation  and  hurried  breathing  on  ascend- 
ing a  height  or  engaging  in  any  considerable  bodily 
exertion ;  attended  with  a  livid  appearance  of  the  lips, 
evidencing  a  difficulty  in  the  passage  of  blood  through 
the  lungs. 

It  was  determined  to  put  her  upon  the  use  of  Calomel 
and  Pulv:  Jacob:  which  were  given  in  small  doses  every 
night  and  morning ;  a  blistering  plaister  was  also  applied 
to  the  chest,  and  kept  in  an  irritable  state  for  a  considera- 
ble length  of  time.  The  diet  was  ordered  to  be  soft, 
mild  and  nutritious.  The  mercury  and  antimonial 
medicine  were  occasionally  omitted  when  they  acted  more 
on  the  bowels  than  the  skin,  or  occasional  anodynes  were 
administered  to  restrain  their  action  on  the  alimentary 
canal. 

Some  weeks  elapsed  before  the  mercury  produced  any 
effect  upon  the  salivary  glands,  wrhich  was  one  of  the  ob- 


44 

jects  aimed  at.  As  soon  as  the  mouth  became  sensibly 
aiiected,  the  symptoms  were  generally  mitigated.  A  tem- 
porary suspension  of  the  use  of  the  remedies  became  ne- 
cessary, iu  consequence  of  the  considerable  effect  produ- 
ced by  the  mercury.  When  the  soreness  of  the  mouth 
abated,  small  and  less  frequent  doses  of  the  calomel  were 
given  so  as  to  keep  up  a  tenderness  of  the  gums  several 
weeks  longer.  The  affection  of  the  chest  became  now  en- 
tirely relieved,  and  it  was  thought  advisable  to  suspend 
the  use  of  the  mercurial  treatment,  the  effects  of  which 
were  suffered  to  pass  off,  rather  than  be  relieved  or 
cured. 

From  this  time  no  medicines  were  employed,  except  a 
small  quantity  of  a  weak  infusion  of  Colombo  as  a  tonic. 
Long  before  the  patient's  mouth  enabled  her  to  eat,  her 
appetite  became  craving.  She  was  indulged  in  eating 
moderately  of  such  food  as  she  had  a  particular  desire 
for;  and  she  soon  was  enabled  to  take  exercise  without 
inconvenience.  She  did  not  now  complain  of  any  pain 
in  the  chest,  the  cough  left  her,  the  bowels  became  re- 
gular, there  was  no  recurrence  of  night  sweats,  she  began 
to  gain  flesh,  the  countenance  assumed  the  healthy  as- 
pect, and  the  peevishness  under  which  she  had  long  la- 
boured was  effectually  cured,  She  now  slept  well,  and 
gradually  returning  to  her  former  habits,  is  at  the  end  of 
five  months  after  discontinuing  her  remedies,  in  perfect 
health." 

Digitalis  is  a  remedy  in  Phthisis,  which  has  excited 
much  acrimonious  controversy  among  practitioners  of 


medicine.     As  always  happens  in  these  contests,  it  bas 
been  praised  too  highly  by  one  party,  and  condemned  too 
severely  by  the  other.     When  first  introduced,  it  seemed 
to  promise   the    complete   eradication  of  Consumption ; 
and  it  almost  appeared  that  digitalis  was  as  specific  in 
the  cure  of  that  disease,  as   mercury,  in  syphilis.     Dr. 
Magennis    of  the    Royal  Xavy  Hospital    at    Plymouth, 
England,  published  a  paper,  containing  an  account  of  se- 
venty-two cases  of  incipient  or  confirmed  Consumption,  in 
seamen  and  marines,    treated   with  digitalis.     Of  these, 
twenty-five  with  ulcerated  lungs  recovered;    and  fifteen 
from  the  stage  previous  to  ulceration.     Thirteen  of  the 
seventy-two    in  an   early   stage  of  ulceration  were   dis-- 
charged,  greatly  relieved  ;  and  nine  in  the  previous  stage. 
In  ten  cases,  the  medicine  failed ;  but  in  some  of  these  it 
gave  considerable  relief.     Beddoes  assures  us,  that  three 
cases  out  of  five  of  tubercular  consumption,  in  his  prac- 
tice, had  recovered  under  the  use  of  digitalis.     Kinglake 
insists  that  one  in  three  cases  of  the  tubercular  stage  of 
Consumption,  may  be  cured  by  this  medicine.     Dr.  Cur- 
rie  informs  us,  that  digitalis  may  be  used  with  safety  and 
success  in  cases  where  the  lancet  can  no  longer  be  em- 
ployed.    These  results  in  the  practice  of  men,  distinguish- 
ed in  their  profession,  although  they  may  be  somewhat 
-warped  by  prejudice,  are  extremely  flattering,  and  prove 
at  least  that  the  medicine  has  some  power.     But  like  all 
other  new  remedies,  digitalis   has  been  rated  too  highly 
by  those  who  first  used  it.     Delighted  that  they  had  dis- 
covered a  medicine,  which,  in  some  cases  would  cure  a 


46 

disease,  which  they  had  been  accustomed  to  look  upon  as 
totally  incurable,  these  physicians  have  suffered  them- 
selves to  attend  too  exclusively  to  its  successful  results, 
and  to  neglect  cases  in  which  it  has  failed.  Other  prac- 
titioners, on  reading  their  exaggerated  statements,  have 
tried  the  remedy,  but  finding  themselves  frequently  dis- 
appointed, have  gone  into  the  other  extreme  and  con- 
demned it  entirely.  Their  representations  are  to  be  ad- 
mitted with  as  much  qualification  as  those  of  their  op- 
ponents, and  the  judicious  physician  will  not  suffer  him- 
self to  be  exclusively  guided  by  either.  That  in  certain 
cases,  digitalis  will  cure  Consumption,  cannot  be  doubted  ; 
but  we  have  also  to  regret,  that  it  very  frequently  fails. 
It  was  prescribed  in  the  New-York  Hospital,  under 
the  direction  of  Dr.  Hamersley,  during  the  last  winter, 
in  six  cases  which  I  have  witnessed,  of  evident  and  well 
marked  Phthisis.  Of  these,  two  patients  were  perfectly 
cured;  one  has  nearly  recovered,  and  is  only  retained  in 
the  Hospital  for  a  slight  cough,  which  is  yielding ;  a  fourth 
was  discharged  at  his  own  request,  but  evidently  re- 
lieved ;  the  fifth  commenced  the  use  of  digitalis,  at  a 
very  advanced  period  of  the  disease,  and  soon  died;  in 
the  last  it  failed  entirely,  and  appeared  rather  to  have 
done  injury. 

Having  ascertained  that  digitalis  does  sometimes  suc- 
ceed in  curing  Phthisis  Pulmonalis,  it  remains  to  discover 
what  are  the  cases  in  which  we  may  exhibit  it  with  success. 
For  this  purpose  it  would  be  desirable  to  ascertain  the 
modus  operandi  of  the  medicine.     Here  writers  have  differ- 


47 

ed  as  widely  as  in  their  account  of  its  success  in  practice. 
One  author  determines  it  to  act  by  diminishing  the  force 
and  frequency  of  the  circulation,  and  reducing  inflamma- 
tory action  ;  a  second  attributes  its  salutary  effect  to  its 
operation  on  the  kidneys;  while  a  third  believes  it  no 
longer  to  be  of  advantage,when  it  increases  the  discharge  by 
urine,  excites  nausea,  vomiting,  purging  or  any  undue  ex- 
citement, but  attributes  its  beneficial  effects  to  its  stimu- 
lant efficiency,  in  invigorating  the  arterial  and  muscular 
energy  of  the  system:  and  a  fourth  insists  that  by  promo- 
ting the  action  of  the  absorbents  it  cures  Consumption. 
These  conflicting  and  opposite  opinions  constrain  us  to 
admit,  that  farther  enquiry  is  necessary,  before  we  can 
rest  satisfied  as  to  the  mode  in  which  digitalis  acts.  It 
must  be  confessed  that  this  medicine  is  extremely  uncer- 
tain in  its  operation.  Its  most  evident  effect,  and  that 
most  insisted  on,  of  reducing  the  frequency  of  the  pulse,  is 
by  no  means  certain;  and  indeed,  it  is  the  opinion  of  Dr. 
Beddoes,  that  the  force  and  strength  of  the  pulse  are 
increased  by  it.  In  the  N.  Y.  Hospital  I  have  witnessed 
frequent  cases  in  which  it  s  continued  exhibition  produced 
no  effect  in  reducing  either  the  force  or  frequency  of  the 
pulse  ;  and  in  some  inst  ances  no  effect  at  all  seemed  to 
be  produced  by  it.  A  case  occurred  in  that  institution  in 
October  last,  in  which  a  patient,  by  his  own  carelessness 
took  six  drachms  of  Tinct:  Digitalis  with  no  evident  injury. 
In  examining  the  effect  of  this  medicine  on  the  pulse,  it 
is  necessary  to  recollect  the  remark  of  Beddoes,  that  it  is 
verv    different  in   the    recumbent    and    erect    posture; 


48 

the  pulse  frequently  being  found  to  be  reduced  m 
frequency  and  irregular  in  the  former,  but  recovering 
its  frequency  and  regularity  in  the  latter  situation. 
From  the  same  author  we  learn,  that  if  this  remedy  do  not 
produce  any  good  effect  witnin  three  weeks,  we  can  ex- 
pect no  advantage  from  it  at  all.  It  is  generally  admitted 
that  digitalis  will  succeed  only  in  the  first  stage  of 
Phthisis  Pulmonalis;  in  the  last  or  ulcerated  stage  of  that 
malady,  it  will  not  save  our  patient,  but  we  are  apprehen- 
sive, will  rather  hasten  his  dissolution.  As  it  is  ack  no  wledg- 
ed  to  be  an  uncertain  medicine,  we  should  not  place  our 
whole  dependence  upon  it,  nor  suffer  it  to  take  the  place 
of  blood-letting  and  the  rest  of  the  antiphlogistic  treat- 
ment before  recommended :  it  should  be  used  rather  as 
an  auxiliary  than  a  principal  remedy.  From  it3  uncertainty 
of  operation  it  requires  a  cautious  exhibition.  The  dose 
for  an  adult  is  from  ten  to  fifteen  drops  of  the  saturated 
tincture,  three  times  a  day,  and  gradually  increased  until 
some  effect  is  produced. 

The  use  of  factitious  airs  in  Consumption  is  now  very 
much  abandoned.  No  essential  benefit  has  ultimately 
appeared  to  be  derived  from  them;  although  in  the 
first  instance,  they  produced  some  apparently  good 
effect. 

Of  much  more  advantage  is  a  sea-voyage  and  a  mild 
climate.  The  benefit  evidently  derived  from  sea-voyage* 
has  been  attributed  to  various  causes.  The  nausea  and 
vomiting  from  sea-sickness,  the  uniform  motion  and  srentle 
regular  exercise  produced  by  sailing,  and  the  uniformity 


49 

and  mildness  of  the  atmosphere  of  the  ocean,  so  evident 
at  a  distance  from  the  land,  probably  all  combine  in  pro- 
ducing these  happy  results.  We  can  hardly  suppose, 
however,  with  Dr.  Mudge,  that  the  exhalations  from  the 
tar  and  pitch  about  the  ship,  taken  into  the  lungs  in 
respiration,  have  any  agency  in  the  effect  produced.  But 
whatever  be  the  cause,  it  is  not  at  all  unfrequent  for 
consumptive  patients  to  experience  immediate  relief 
after  having  been  a  few  days  at  sea.  A  sea-voyage  to 
produce  permanent  benefit,  should  be  long  continued, 
and  what  is  of  still  more  importance,  terminate  in  a 
mild  climate.  Every  winter,  instances  occur  in  this 
city,  of  consumptive  patients  being  restored  to  health 
by  a  voyage  to  the  south  of  France,  or  some  other 
country  of  similar  temperature.  The  climate  most 
grateful  to  these  patients  is  one  whose  temperature  is 
uniform,  not  subject  to  any  sudden  variations,  and  where 
the  atmosphere  is  dry  and  pure.  The  island  of  Ma- 
deira possesses  all  these  requisites.  The  part  of  it  best 
adapted  to  the  purpose  in  question  is  thus  described  by 
Dr.  Adams,  a  physician  of  that  island,  in  a  letter  to  hie 
friend  in  London  : — 

"  The  valley  of  Funchall  is  defended  by  immense  hills 
from  every  wind  but  the  south,  where  it  is  open  to  the 
sea-breeze;  this  preserves  a  temperature  so  even,  as  is 
unknown  in  any  other  part  of  the  world.  Our  winters 
may  be  compared  to  your  summers  in  every  thing  but 
the  length  of  days,  and  those  sudden  changes  from 
heat  to  cold,  to  which  you  are  subject-     The  thermome- 


50 

ter  with  us  is  often  steady  within  doors,  or  vanes  scarcely 
a  degree  for  weeks  together.  During  winter  its  whole 
range  is  from  58  to  65 ;  and  in  summer,  from  70  to  75* 
rarely  amounting  to  80  ;  the  heat  being  always  tempered 
by  a  breeze  in  proportion  to  the  force  of  the  sun.  The 
dryness  of  our  atmosphere  is  not  less  remarkable." 

If  this  description  be  correct,  Madeira  has  a  climate 
possessing  every  requisite  to  make  it  most  favourable  to 
phthisical  patients.  The  southern  parts  of  the  United 
States  are  frequently  resorted  to,  also,  by  the  consump- 
tive with  great  benefit.  I  have  had  the  satisfaction  of 
seeing  a  young  friend  return  from  Charleston,  a  short 
time  since,  perfectly  restored  to  health,  who,  during  the 
last  autumn,  was  attacked  with  repeated  haemoptysis 
and  other  symptoms  of  Incipient  Phthisis. 

It  is  to  be  regretted,  that  change  of  climate,  a  remedy 
of  so  much  advantage  in  the  early  stage  of  Consumption, 
should  so  often  be  postponed,  until  no  possibility  of 
recovery  remains.  It  is  too  often  the  fate  of  such  pa- 
tients, to  leave  their  homes  in  quest  of  health,  merely  to 
find  a  foreign  grave;  resorting  to  that  remedy  which 
should  have  been  first,  as  the  last  effort  of  despair.  To 
this  cause  alone,  may  we  attribute  its  frequent  inefficiency, 
and  unfortunately  the  same  cause  has  contributed  too  much 
to  bring  the  remedy  into  disrepute* 

Where  from  any  circumstances,  change  of  climate  is 
impracticable,  it  may  to  some  extent  be  imitated,  by  con= 
fining  the  patient  to  apartments  whose  temperature  is  kept 
constant  and  uniform,     This  has  been  tried  and  with  some 


51 

success  ;  and  is  probably,  the  remedy  of  the  same  class, 
next  in  power,  but  much  inferior  to  a  warm  climate. 
Beddoes  made  use  of  it  in  several  cases  with  relief  to  his 
patients,  but  it  has  not  yet  been  sufficiently  tested  to 
establish  its  character  as  a  remedy  in  Phthisis  Pul- 
monalis. 

Besides  the  use  of  the  remedies  which  have  been 
enumerated,  with  the  view  of  effecting  a  radical  cure  of 
this  disease,  there  are  some  symptoms  occurring  in  its 
first  stage,  which  require  immediate  relief.  Haemoptysis 
sometimes  comes  on  in  such  a  manner  as  to  be  very 
alarming  to  the  patient.  Blood-letting  in  large  quantities, 
and  repeated  in  proportion  to  the  strength  and  habit  of 
the  patient  and  violence  of  the  symptoms,  is  then  ab^ 
solutely  necessary.  Unless  the  plethora,  which  is  oppres- 
sing the  system,  and  exciting  the  haemorrhage  from  the 
lungs,  be  relieved  by  general  blood-letting,  blood  will  not 
cease  to  pour  out  from  that  viscus.  At  the  same  time 
the  free  exhibition  of  saline  cathartics,  a  blister  to  the 
chest,  a  rigidly  abstemious  diet  and  a  strict  adherence 
to  the  antiphlogistic  regimen  must  accompany  this 
treatment.  Peruvian  Bark,  Chalybeates  and  Elixir  of 
Vitriol  so  often  used,  in  active  haemorrhage  during  the 
inflammatory  stage  of  Consumption  cannot  but  be 
injurious.  They  increase  the  force  of  the  circulation 
and  consequently  the  disposition  to  haemorrhage.  In 
the  same  symptom  arising  from  an  opposite  cause,  they 
may  be  prescribed  with  advantage.  Common  salt, 
administered  dry  in  the  manner  directed  by  Dr.  Rush? 


52 

has  been  found  by  experience  to  be  very  useful  in  abating 
haemorrhage  from  either  cause;  but  it  should  not  be 
depended  on  alone,  nor  suffered  to  take  the  place  of  the 
treatment  just  detailed. 

If  possible,  we  should  anticipate  the  occurrence  of 
haemoptysis  with  our  remedies,  and  thus  prevent  the 
formation  of  a  habit  of  spitting  blood,  which  when  once 
established,  is  difficult  to  destroy.  The  usual  precursors 
of  this  symptom  are,  a  saltish  taste  in  the  mouth,  a  sense 
of  irritation  at  the  upper  part  of  the  trachea,  and  some 
oppression  and  difficulty  of  breathing.  At  this  time, 
before  the  haemorrhage  has  commenced,  blood-letting 
and  the  rest  of  the  remedies  mentioned  above  should  be 
actively  exhibited.     "  Venienti  occurrite  morbo" 

A  distressing  cough  at  this  period  also  requires  the  at- 
tention of  the  physician.  From  its  occurrence  more  par- 
ticularly at  night,  it  disturbs  the  rest  and  adds  much  to  the 
sufferings  of  the  patient.  It  should  be  alleviated  by 
Opiates,  accompanied  with  any  of  the  mild  demulcent  rem- 
edies, generally  denominated  Pectorals.  Mudge's  Appa- 
ratus for  inhaling  the  steam  of  warm  water,  may  also  be 
used  with  relief,  especially  on  going  to  bed. 

When  all  inflammation  is  gone  and  the  second  stage  of 
Consumption  has  decidedly  formed,  a  different  mode  of 
treatment  becomes  necessary.  Little  indeed  is  now  to  be 
hoped  for  from  any  treatment,  as  a  radical  cure  ;  but  our 
patient  is  not  to  be  abandoned;  if  he  cannot  be  cured,  his 
sufferings  may  be  materially  mitigated,  and  he  may  be  di- 
rected to  avoid  such  things  as  may  increase  his  malady. 


33 

Nor  should  we  entirely  despair  of  performing  a  radical 
cure ;  ior  solitary  cases  are  related  by  many  authors  of 
consumptive  patients  being  cured  in  every  stage  of  the 
disease.  Many  of  these  cases,  perhaps,  have  been  mistaken 
for  Phthisis  Pulmonalis ;  but  of  some  of  them  we  cannot 
doubt.  The  authority  from  which  they  come  is  too 
high  to  permit  us  to  hesitate. 

The  remedies  last  mentioned  in  the  treatment  of  the 
first  stage  of  Consumption  may  yet  be  proper,  and  although 
with  not  so  great  a  prospect  of  success,  should  still  be  tried. 
These  are  a  sea-voyage,  change  of  climate,  and  confine- 
ment to  apartments  whose  temperature  is  regulated.  But 
all  the  debilitating  remedies  before  recommended,  are  now 
to  be  avoided.  The  lancet  in  general  is  improper,  although 
in  some  few  instances,  the  occurrence  of  acute  inflammation 
at  this  period,  still  requires  its  cautious  use.  Drastic  Ca- 
thartics should  not  be  used ;  the  bowels  if  torpid  must  be 
kept  open  by  gentle  laxatives  and  Enemata.  Antimo- 
nial  and  other  debilitating  Emetics  should  not  now  be  ex- 
hibited, but  the  Vitriol  Emetics  may  still  be  prescribed 
with  advantage.  The  Sulphate  of  Zinc  given  in  such  do- 
ses as  to  excite  occasional  vomiting,  is  frequently  very  use- 
fill,  and  especially  where  much  irritation  is  present.  It 
was  introduced  and  strongly  recommended  by  Dr.  Mosely 
in  his  Treatise  on  Tropical  Diseases  &c.  His  Vitriolic  so- 
lution11 is  certainly  an  useful  remedy  in  relieving  dyspnoea 

h   $.  Vitriol :  alb :   5  iij 

Aium  :  rup  ;   3  j 

Coccirmel :  puiv  :  griij 

Aq:  fervent:  $33.  Misce  in  mortareo  marmoreo.  So- 
hitio  a  fseculantia  vel  residendo  espurgetur,  vei  per  chartam  bi- 
bulam  filtretur.    Dos.    §ssi— ■ 


and  promoting  expectoration.  Instead  of  debilitating  cv 
antimoniais  do,  he  assures  us,  that  its  emetic  effects  are  in- 
stantaneous, not  harassing  the  patient,  but  always  leav- 
ing the  stomach  strongly  invigorated.  Mr.  Warburton, 
the  present  House  Physician  of  the  New- York  Hospital, 
has  assured  me,  that  he  has  frequenty  prescribed  it  in  thai 
Institution  wTith  evident  benefit.  With  similar  intentions, 
Dr.  Senter,  in  the  Medical  and  Chirurgical  Review,  pub- 
lished in  1795,  recommends  the  sulphate  of  copper. 

At  this  time  blisters  will  be  preferable  to  either  setons 
or  issues,  as  they  relieve  the  local  symptoms  without 
producing  a  constant  debilitating  discharge.  Indeed 
they  should  be  used  in  such  a  manner,  as  to  produce  as 
little  discharge  as  possible.  With  this  view,  they  should 
not  be  kept  open  by  stimulating  dressings,  but  be  healed 
up,  and  occasionally  renew~ed.  With  the  same  intention, 
stimulating  plaisters  may  be  applied  to  the  chest  with 
advantage,  and  in  general  are  preferable  to  blisters. 

To  support  the  patient's  strength,  as  was  proposed  in 
the  second  indication,  tonics  are  necessary.  Of  these 
some  of  the  simple  bitters  are  preferable,  as  columbo, 
gentian,  boneset,  chamomile,  &c.  But  we  should  be 
careful  not  to  exhibit  them  during  the  paroxysms  of 
hectic  fever,  but  during  its  intervals.  Peruvian  bark 
has  not  been  found  admissible.  It  produces  a  sense  of 
stricture  and  oppression  of  breathing,  adds  to  the  cough, 
makes  the  pulse  quick  and  hard,  and  haemoptysis  is  not 
unfrequently    the  consequence   of  its   exhibition.     Dr, 


Fothergill  dwells  particularly  on  the  abuse  of  this  medr= 
tine  in  Consumption. 

As  stimulating  and  bitter  medicines,  the  Poiygala 
Seneka  and  Aristolochia  Serpentaria  have  been  recom- 
mended  in  this  stage  of  Phthisis  Pulmonalis. 

The  stimulating  balsams  and  gums  are  also  proper  in 
this  stage.  They  have  been  highly  recommended  by 
Morton  ;  and  myrrh  in  particular  is  prescribed  with  great 
confidence  by  Simmons.  They  are  objected  to  by  .Fo- 
thergill, on  the  ground,  that  by  their  stimulating  pro- 
perties, they  increase  the  inflammation  of  the  lungs.  His 
objection  appears  well  founded,  while  symptoms  of  acute 
inflammation  still  exist;  but  after  they  have  subsided, 
the  cough  and  other  distressing  symptoms  of  the  last 
stage  of  Phthisis,  may  be  much  alleviated  by  these  medi- 
cines. By  their  stimulating  effects  upon  the  whole 
system,  also,  they  may  be  useful  at  a  time  when  the  pa- 
tient is  sinking  under  great  debility. 

As  stimulating  applications  are  frequently  found  ne- 
cessary and  useful  to  indolent  ulcers  on  the  surface  of  the 
body,  it  naturally  occurred  that  similar  applications 
might  be  made  with  advantage  to  ulcers  of  the  lungs. 
With  this  view,  the  steam  of  tar  water,  and  the  vapour 
of  sulphuric  aether  inhaled  in  respiration,  have  been  used 
in  the  treatment  of  Consumption.1     With  the  same  re- 

i  Dr.  Borrowe  formerly  had  a  patient  labouring  under  Consumption,  a  manu- 
facturer of  tin  ware,  who  was  uniformly  relieved  of  his  phthisical  symptoms 
when  engaged  in  soldering  tin,  a  process  in  which  a  great  deal  of  resin  is  used, 
and  constantly  inhaled  in  respiration. 


Ob 

sfcrictions  as  are  necessary  with  the  stimulating  gums 
and  balsams,  these  remedies  may  be  beneficial.  It  is  not 
probable,  however,  that  any  permanent  relief  can  be 
derived  from  them  ;  they  can  only  mitigate  symptoms. 

To  check  the  profuse  sweats,  which  occur  at  this  pe- 
riod, and  add  materially  to  the  debility  of  the  patient,  the 
elixir  of  vitriol  is  an  useful  medicine.  As  a  general  to- 
nic it  acts  beneficially  also  upon  the  whole  system. 

With  the  view  of  quietting  the  cough  and  procuring 
rest  at  night,  opiates  are  necessary ;  and  fortunate  are  we 
that  we  have  in  our  possession,  a  remedy,  which  although 
it  will  not  permanently  cure  the  disease,  palliates  the 
symptoms,  at  least  for  a  time  ;  and  makes  more  smooth 
the  path  to  death.  It  is  true  that  opium  produces  some 
ill  effects.  It  debilitates  the  stomach,  and  injures  the 
appetite ;  but  when  the  S3'mptoms  are  urgent,  it  cannot 
for  those  reasons  be  dispensed  with.  By  lulling  pain, 
and  giving  rest  to  the  watchful  patient,  it  more  than 
counterbalances  these  disadvantages.  The  humulus  lu- 
pulus  or  common  hops,  does  not  possess  the  objection- 
able properties  of  opium,  but  with  its  anodyne  combines 
some  tonic  powers,  and  promises  to  be  an  excellent  sub- 
stitute for  that  medicine. 

The  large  and  frequent  use  of  syrups  in  the  form  of  ex- 
pectorant mixtures  and  linctuses,  to  alleviate  cough,  is 
very  injurious.  They  cloy  the  appetite,  destroy  the  tone 
of  the  stomach,  and  prevent  the  taking  of  nutritious  ali- 
ment, which  is  now  so  necessary  ;  and  frequently  without 
producing  any  material  relief  of  the  symptom  for  which 
they  are  prescribed. 


57 

The  use  of  opiates  is  necessary  also,  to  check  the  pre* 
fuse  diarrhoeas,  which  now  alternate  with  costiveness, 
and  reduce  the  already  debilitated  patient.  With  the 
same  view,  the  chalk  mixture  may  be  used  with  advantage, 
and  the  astringent  medicines,  Kino  and  Catechu,  with 
others  of  the  same  class. 

It  is  not  unfrequent  for  haemoptysis  to  occur  at  this 
period,  as  well  as  in  the  earlier  stages  of  Consumption. 
Sometimes  it  is  the  effect  of  some  temporary  excitement, 
and  may  be  relieved  by  the  loss  of  a  few  ounces  of  blood. 
But  frequently  this  evacuation  cannot  be  borne ;  and  the 
haemorrhage  proceeds  rather  from  debility  in  the  vessels 
of  the  lungs,  than  any  increased  force  of  the  circulation. 
We  must  then  trust  to  astringents — muriate  of  soda,  sul- 
phuric acid,  and  alum. 

We  come  now  to   speak  of  the   diet  and  regimen  of 

patients  labouring  under  Phthisis  Pulmonalis ;  a  subject 

no  less  important  than  the   remedies  to  be  exhibited.     In 

the  first  stage,  the  diet  should  be  perfectly  simple,  and 

such  as  will  least  tend  to  increase  the  inflammatory  action 

of  the  system.     For  this  purpose  nothing  is  better  than 

milk.     So  sensible  have  physicians,  at  all  times,  been  of 

its  propriety,  that  in  many  cases,  they  have  trusted  the 

cure  entirely  to  a  milk  diet.     It  is  highly  spoken  of  by 

almost  every  author  who  has  written  on  this  subject, 

and  with  reason.     It  is  light,  easily  digested,  and  does  not 

produce  any  excitement.     Many  have  preferred  Asses'  to 

Cows'  milk,  but  it  does  not  appear  that  there  is  any  material 

difference,    which    should  influence   our   choice.     The 

H 


58 

former  is  thinner  and  less  nutritious,  and  perhaps,  U» 
very  delicate  stomachs,  may  be  more  acceptable  ;  but  in 
general,  the  latter  is  as  useful.  Milk,  however,  is  very 
offensive  to  some  stomachs,  and  not  so  easily  digested  as 
other  food;  in  such  cases  it  must  necessarily  be  pro- 
hibited. 

As  a  general  rule,  with  regard  to  diet,  in  this  stage, 
animal  food  is  improper,  and  the  patient  should  be  con- 
fined to  the  use  of  vegetables.  Fresh  sub-acid  fruits  are 
proper ;  and,  indeed,  of  so  much  importance  have  they 
been  considered,  that  Hoffman  mentions  a  case  of  con- 
firmed phthisis,  cured  by  confining  the  patient  to  the  use 
of  fruits,  and  particularly  strawberries.  Mucilaginous  and 
diluent  drinks,  as  those  formed  from  barley,  sago  and  flax- 
seed are  also  useful.  Among  these  may  be  classed,  the 
Lichen  Islandicus,  which  has  gained  with  some  the  reputa- 
tion of  curing  Consumption.  Weak  is  the  foundation  for 
hope  of  toose  who  depend  on  it.  As  an  article  of  diet, 
from  its  mucilaginous  property,  it  is  useful ;  and  in  t'l  e 
last  stage,  from  its  possessing  slightly  better  and  tonic 
virtues,  it  is  also  proper  ;  but  as  a  remedy  for  phthisis  it 
is  altogether  inert.  Nor  are  its  tonic  powers  sufficiently 
great,  to  render  it  injurious  in  the  early  stage  of  the 
disease. 

The  dress  of  the  patient  should  also  be  regulated  by 
the  Physician.  He  should  be  clothed  in  flannel,  and 
this  frequently  changed.  A  constant  determination  is 
thus  kept  up  to  the  surface,  and  to  some  extent,  diverted 
from  the  chest.     At  the  same  time,  all  exposure  to  cold, 


moisture,  or  sudden  alternations  of  temperature  must  be 
studiously  avoided.  As  in  many  cases,  they  lay  the  founda- 
tion for  consumption,  so  after  it  has  commenced,  their 
-repetition  aggravates  it. 

Mental  distress  and  consequent  despondence,  impedes 
the  cure  of  those  who  otherwise  might  recover^  and  should 
be  obviated  as  much  as  possible.  Happily,  patients  labour- 
ing  under  Phthisis,  generally  with  difficulty,  resign  hopes  of 
recovery,  and  despondence  from  that  source  does  not  often 
depress  them.  But  mental  anxiety,  produced  by  other 
causes,  is  very  injurious.  It  should  be  relieved,  as  much 
as  possible,  by  pleasant  amusements,  a  journey,  a  sea-voyage 
or  any  other  method  most  suited  to  the  particular  circum- 
stances of  the  patient. 

In  the  second  stage  of  Consumption,  the  diet  of  the  pa- 
tient must  be  altered,  as  well  as  the  medical  treatment.  The 
most  nutritious  articles  of  food  are  then  to  be  chosen, 
and  such  as  are  at  the  same  time  the  most  easily  di- 
gested. It  is  we'll  ascertained  that  the  older  meats,  as 
beef  and  mutton,  possess  these  properties  in  a  higher  de- 
gree than  veal  or  lamb ;  and  generally,  the  brown  more  than 
white  meats.  With  the  same  view,  w^ild  fowl  and  game 
generally,  form  nutritious  articles  of  diet,  proper  for  con- 
sumptive patients.  Eggs  combine  a  large  quantity  of  nour- 
ishment in  a  small  compass,  and  may  be  freely  used.  They 
should  be  taken  either  quite  raw,  or  boiled  a  very  few 
minutes.  When  boiled  hard,  they  form  one  of  the  most 
indigestible  and  offensive  substances,to  the  delicate  stomach, 
thai:  are  used  in  diet.  The  various  culinary  preparations, 
of  which  eggs  form  a  principal  part,  are  for  the  same  rea^ 


60 

sons  proper.  Jellies  also  contain  a  great  quantity  of  nu- 
tritious matter,  and  are  very  acceptible  to  patients,  who,  as 
in  Consumption,  have  little  appetite.  Oysters  and  some 
other  of  the  testacea,  are  also  extremely  nutritious.  Isin- 
glass boiled  in  milk  is  frequently  in  use,  and  with  advantage, 
in  these  cases.  Of  the  vegetable  nourishments,  those  should 
be  chosen  which  are  most  nutritious  and  abounding  in  mu- 
cilage, as  rice,  sago,  arrowroot  and  Tapioca.  Chocolate^ 
when  prepared  in  such  a  manner  as  to  be  free  from  oily 
matter,  is  a  very  pleasant  article  of  diet. 

The  drinks  of  the  patient  should  also  be  stimulating  and 
nutritious.  Malt  liquors  combine  both  these  properties  with 
some  tonic  virtues,  which  they  obtain  from  the  bitter  of 
the  hops  infused  in  them,  and  therefore  constitute  the  best 
drink  for  consumptive  patients.  Wine,  also,  may  be  used 
moderately  with  advantage,  but  requires  some  caution ;  and 
should  be  immediately  abandoned,  if  any  undue  excitement 
be  produced  by  it. 

In  this,  as  in  every  other  stage  of  Consumption,  while 
the  patient  has  sufficient  strength,  exercise  is  neces- 
sary to  the  recovery  of  health.  Of  so  much  importance 
is  exercise,  that  in  many  cases,  it  has  alone  cured  this  dis- 
ease. Dr.  Rush  relates  many  such  cases,  and  particularly  ^ 
three  instances  of  persons  in  confirmed  consumptions,  per- 
fectly cured  by  the  hardships  of  a  military  life.  Of  so 
much  consequence  was  it  in  the  eyes  of  Sydenham,  that  he 
pronounced  riding  on  horseback,  as  certain  a  cure  for  con- 
sumptions, as  bark  for  an  intermittent  fever.  Indeed,  all 
Writers  on  this  disease  join  in  recommending  it,  not  onty 


61 

as  a  part  of  the  regimen,  but  as  a  principal  remedy  in  the 
treatment.     The  mode  of  exercise  to  be  chosen*  should  de- 
pend entirely  on  the  situation  of  the  patient,  at  the  time. 
While  much  pain  and  soreness  subsist,  denoting  the   pre- 
sence of  active  inflammation,  the  most  gentle  exercise  only 
should  be%  used  :  at  that  time  riding   in  a  carriage  or  on 
horseback,  would  be  as  improper  as  for  a  patient  labouring 
under  pleurisy.     The  swing,  so  highly  recommended  by 
Dr.  Carmichael  Smyth,    is  the  least  fatiguing,   and  most 
gentle  mode  that  can  be  adopted.     It  may  be  serviceable, 
too,  when  the  patient  is  too  much  debilitated  to  bear  other 
more  fatiguing  exercise.     But  I  would,  by  no  means,  adopt 
the  opinion  of  Carmichael  Smyth,  that  the  swing,  in  itself, 
and  unassisted  by  other  remedies,  will  cure  Consumption, 
Experience  has   proved  the  contrary  ;   and  has  taught  us 
that  it  is  only  useful  as  an  article  of  regimen,  while  the  pa- 
tient  is  under  the  influence  of  other  more  powerful  reme- 
dies.    When  there    is  sufficient  strength  to  bear  it,  and 
not  too  much  excitement,  riding  in  an  easy  carriage  is  the 
next  mode  of  gestation  which  may  be  used.     But  when  the 
patient  is  enabled  to  ride  on  horseback,  we  have  more  to  ex- 
pect from  it,  than  any  other  species  of  exercise,     To  attain 
the  greatest  benefit  from  it,  it  should  be  made  use  of  regu- 
larly   and    constantly  ;    not  during  the  cold  air  of  early 
morning,  nor  the  dews  of  the  evening,  but  rather  during  the 
day,  after  the  sun  exerts  some  influence.     A  long  journey 
on  horseback  aflbrds  the  most  useful  method  of  obtaining 
all  the  advantages  that  can  be  derived  from  exercise.     It  is 
then  made  constant  and  regular ;  and  the  amusement  af- 


62 

forded  by  travelling  serves  to  divert  the   patient's   mind 
from  his  own  feelings,  and  adds  to  its  beneficial  effects. 

Secondary  Phthisis  Pulmonalis  remains  yet  to  be  treated 
of.  Under  this  order,  should  be  included  every  form  of  Con- 
sumption, in  which  the  system  has  become  debilitated  by 
any  cause,  and  the  lungs  in  consequence  become  affected. 
I  would  exclude  from  it  that  form  of  the  disease  occurring 
after  measles,  scarlatina,  and  some  other  eruptive  diseases, 
which  I  would  consider  as  primary  Phthisis  Pulmonalis  ; 
because,  in  those  cases,  the  lungs  do  not  become  affected 
merely  in  consequence  of  debility,  but  these  diseases  seem 
rather  to  act  as  exciting  causes,  in  constitutions  already 
predisposed  to  Consumption  ;  w^hile  in  secondary  Phthisis, 
the  affection  of  the  lungs  is  only  one  symptom  of  the  gene- 
ral disease,  which  is  wasting  the  body.  Nor  would  the 
treatment,  which  will  be  advocated  in  the  latter  form,  be 
prober  in  the  cases  alluded  to.  They  require  that,  which 
should  be  used  in  the  first  species  of  Phthisis,  and  which 
has  already  been  detailed.  The  reason,  why  the  lungs  be- 
come affected  in  consequence  of  debility  induced  by  parti- 
cular causes,  I  would  not  attempt  to  explain.  It  is  one  of 
those  laws  of  the  constitution,  not  better  understood,  than 
why  particular  parts  are  successively  affected  in  conse- 
quence of  syphilis,  or  that  the  breasts  and  lower  extremities 
are  more  liable  to  disease  than  other  parts,  except  the  ute- 
rus, in  females  after  parturition.  Many  laws  of  this  kind 
exist  in  the  human  constitution,  of  whose  effects,  we  are 
every  day  made  sensible,  but  of  the  cause  of  which  we  arc 
totally  ignorant. 


63 

One  of  the  most  frequent  causes  of  Secondary  Phthisis^ 
is  Chlorosis,  that  disease  which  occurs  in  young  females,  in 
consequence  of  Retention  of  the  menses.  The  constitution 
not  having  sufficient  vigour  to  produce  this  evacuation  at 
the  proper  period,  if  any  predisposition  to  Phthisis  exist, 
a  determination  takes  place  to  the  lungs,  producing  Phthi- 
sical disease.  This  case  is  not  analogous  to  Consumption 
produced  by  Suppression  of  the  menses,  after  they  have 
been  once  established  ;  for  in  that  instance  the  suppression 
is  not  generally  induced  by  debility,  but  by  cold^  or  some 
other  cause,  not  acting  merely  by  weakening  the  patient  ; 
and  it  produces  active  inflammation  of  the  lungs.  But  in 
the  case  before  us,  the  affection  of  the  lungs  is  merely  a 
symptom  of  the  want  of  vigour  in  the  constitution,  which 
shews  itself  in  retention  of  the  menses.  Accordingly,  in  the 
treatment  of  this  disease,  our  attention  must  not  be  direct- 
ed primarily  to  the  affection  of  the  lungs,  but  to  the  state 
of  the  system,  the  cause  of  that  affection. 

Profuse  evacuations,  of  any  kind,  may  be  the  cause  of 
Secondary  Phthisis.  Haemorrhages  from  the  Nose,  Lungs, 
Stomach,  Kidneys  and  wounds  are  all  mentioned  by  Mor- 
ton, as  having  induced  Pulmonary  disease.  Mr  Hey,  in 
his  work  on  Surgery,  observes^  that  he  has  seen  a  great  ma- 
ny cases  of  pulmonary  Consumption,  the  consequence  of 
debility,  induced  by  violent  haemorrhages,  and  in  persons 
who  had  no  apparent  tendency  to  Consumption.  In  the 
same  manner,  loss  of  blood  from  Haemorrhoids  and  in 
Menorrhagia,  may  act  as  causes.  Debilitating  evacuations, 
by  means  of  Diarrhcsa,  Diabetes,  Salivation,  and  Sweatings 


64 

have  had  the  same  effect.  But  the  most  frequent  causes  of 
this  class  are,  immoderate  discharges  by  flucr  alius,  and  too 
long  suckling  by  delicate  woman  of  robust  children.  They 
are  particularly  mentioned  by  Morton  and  Fothergill,  and 
have  been  adverted  to  by  most  authors,  who  have  written 
since. 

Chronic  Catarrh,  terminating  in  Phthisis,  may  be  rank- 
ed also  in  this  class.  The  profuse  and  long  continued  dis- 
charge from  the  membrane  lining  the  trachea  and  bronchia?, 
is  the  debilitating  agent  in  that  case. 

Long  continued  Fevers,  and  particularly  Intermittent 
fevers,  not  unfrequently  leave  behind  them,  a  state  of  de- 
bility, sufficient  to  induce  Consumption. 

In  the  New- York  Hospital,  frequent  instances  occur  of 
Consumption  induced  by  intemperance  in  the  use  of  ardent 
spirits.  This  habit  destroys  the  tone  of  the  stomach, 
which  becomes  primarily  affected,  and  in  consequence  the 
whole  system  becomes  debilitated,  terminating  in  disease 
of  the  Lungs. 

Secondary  Consumption  has  also  been  induced  by  some 
other  preceeding  diseases,  such  as  Scurvy  and  Syphilis, 
and  requires  the  attention  of  the  Physician,  to  the  primary 
disease  rather  than  to  the  affection  of  the  Lungs. 

In  the  treatment  of  Pulmonary  Consumption,  arising  from 
any  of  these  or  analogous  causes,  cur  attention  is  first  cal- 
led to  the  removal  of  the  primary  source  of  the  disease. 
If  it  be  Chlorosis,  remedies,  calculated  to  cure  that  malady, 
must  be  prescribed.  If  profuse  evacuations  are  the  cause, 
all  the  means  in  our  power,  must  be  employed  in  restraining 


65 

those  evacuations.  If  the  disease  has  been  induced  bv  the 
long  continued  suckling  of  a  vigorous  child,  bv  a  delicate 
mother,  another  nurse  mnst  be  provided,  or  the  child  must 
be  weaned.  If  Scurvy  or  Syphilis  have  produced  it,  the 
proper  remedies  for  those  disorders  must  be  employed. 

Our  next  object  is  to  remove  the  debility,  the  cause  of 
the  pulmonary  symptoms.  For  this  purpose,  Tonics  are  in- 
dicated, and  at  their  head  stands  the  Peruvian  Bark.  In  the 
other  species  of  Phthisis,  this  medicine  has  been  much 
abused,  but  in  the  present  one,  its  use  is  sanctioned  by  ex- 
perience. In  the  cases  proceeding  from  Leucorrhcea,  and 
long  suckling,  it  is  highly  recommended  by  Dr  Fothergill; 
but  he  cautions  us  against  persevering  in  its  use,  longer 
than  while  it  is  doing  good  ,*  and  remarks,  that  if  the 
breathing  become  more  ppressed,  the  cough  drv,  the  pulse 
more  quick  and  hard,  and  especially,  if  slight  transitory- 
pains  or  stitches  about  the  thorax,  are  more  frequently 
complained  of,  a  perseverance  in  the  use  of  he 
bark  will  increase  the  disease.  If,  in  consequence  of  ihis 
increase  of  symptoms,  we  are  obliged  to  desist  in 
the  use  of  the  Bark,  other  Tonics  must  be  substituted. 
The  combination  of  bitter  and  tonic  medicines  in  the  Infus: 
Amar:  of  the  dispensatories  may  be  then  usefully  prescri- 
bed. Columbo,  which  is  sometimes  an  ingredient  in  that 
formula,  is  particularly  recommended  by  Dr.  Thomas  Per- 
cival,  as  not  possessing  any  of  the  injurious  properties  of 
bark. 

The  Elixir  of  Vitriol  is  also  an  excellent  tonic,  and  may 
be  usefully  given  at  the  same  time  with  the  remedies  just 


66 

proposed.  But  it  requires  to  be  administered  with  the 
same  cautious  hand  as  the  bark,  and  to  be  discontinued,  if 
the  symptoms  appear  to  be  at  all  aggravated  by  its  use.  In 
general,  no  ill  effects  arise  from  it,  but  if  the  determination 
to  the  chest  be  so  great,  as  to  produce  much  inflammatory 
action,  it  may  do  injury.  Independent  of  its  tonic  powers^ 
it  will  be  serviceable  in  checking  any  disposition,  which 
may  exist,  to  profuse  sweating. 

Iron,  in  its  various  officinal  preparations,  is  also  a  good 
remedy,  in  this  form  of  phthisis.  Although,  highly 
dangerous  in  the  primary  disease,  there  is  now  little  dan- 
ger of  increasing  the  inflammation,  which  in  that  form, 
made  it  improper.  Mineral  chalybeate  waters,  will  in  this 
instance,  be  useful,  not  only  by  the  journey  to  them,  and 
the  amusement  derived  at  watering  places,  but  may  be 
drank  with  advantage  by  the  patient. 

In  addition  to  these  remedies,  the  diet  and  regimen 
should  be  such  as  is  most  invigorating  to  the  constitution. 
A  nutritious  diet  and  the  moderate  use  of  wine  will  be  pro- 
per ;  and  country  air  and  exercise  with  the  same  rules  as 
were  mentioned  in  the  treatment  of  primary  phthisis,  are 
very  important  circumstances  in  the  cure  of  the  secondary 
form.  A  long  journey,  a  sea-voyage  and  change  of  climate 
are  also  equally  proper. 


The  prominent  feature  and  primary  object  of  this  es- 
say has  been,  to  establish  the  distinction  between  primary 


B7 

and  secondary  Phthisis  Pulmonalis.  Although,  perhaps, 
the  minute  parts  of  the  arrangement  may  not  have  been 
distributed,  in  every  instance,  with  perfect  accuracy,  I 
feel  confident  that  the  general  plan  is  correct.  Farther 
observation  and  experience  will  probably  suggest  a  more 
accurate  disposition  of  the  varieties  of  Phthisis,  under  the 
two  orders  which  I  have  proposed. 

Probably  from  the  want  of  the  distinction  between 
primary  and  secondary  Phthisis,  may  be  explained  the 
Various  and  contradictory  practice,  proposed  by  physicians 
of  deserved  eminence.  A  more  frequent  opportunity  of 
observing  one  or  the  other  form  of  the  disease,  has  de- 
termined with  each,  his  mode  of  treatment :  and  hence  in 
diseases  bearing  the  same  name,  we  may  see  blood-letting 
and  a  rigid  antiphlogistic  regimen  adopted  by  one  party, 
and  bark,  iron,  and  a  nutritious  diet  by  another.  Any 
error  which  may  arise  from  these  contradictions,  may 
be  corrected  by  the  distinction,  which  has  been  pro- 
posed. 

It  has  also  been  my  object,  to  call  the  attention  of  the 
practitioner,  to  the  earliest  symptoms  and  first  dawnings 
of  Consumption.  W  ere  they  not  so  much  neglected  by 
the  physician,  as  well  as  the  patient,  our  bills  of  mortality 
would  not  continue  to  present  so  frightful  a  picture  of  the 
ravages  of  this  disease ;  while,  on  the  other  hand,  a  prompt 
attention  to  these  incipient  symptoms,  and  the  interference 
of  an  active  practice,  would  afford  a  reasonable  prospect 
of  saving  many  from  Consumption,  who  are  now  it* 
victims. 


ERRATA, 

Page  10,  Note,  for  tfapres,  read  D  apres. 

22,  line  25,  for  which  like  the  inert  physician^  read  which  the  inert 

physician. 
25,  line  13,  for  dysentery^  read  dysentery. 


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